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LIBRARY OF CONGRESS 



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THOMAS H. HAINES, M. D., 

Field Consultant, National Committee for Mental Hygiene, Inc., 

New York, N. Y., 

Director. 






Report of the 



Maryland Mental Hygiene 
Survey 

With Recommendations 



SURVEY REQUESTED BY 

The Baltimore Alliance of Social Agencies 
The State Lunacy Commission 
The State Board of Education 



Conducted under the auspices 
of the National Committee for 
Mental Hygiene, Inc., and a 
special advisory Commission 
appointed by Hon. Albert C. 
Ritchie, Governor of Mar viand. 



The report of the Maryland Mental Hygiene 
Survey has been referred to the following special 
committee appointed by Dr. Lewellys F. Barker 
for further consideration and recommendations: 

Judge Jacob M. Moses, Chairman. 
Dr. Adolph Meyer. Dr. Frank W. Keating. 

Dr. Hugh H. Young. Mr. Albert S. Cook. 

Dr. Edward N. Brush Mr. Howard C. Hill. 



THOMAS H. HAINES, M. D., 
Field Consultant, National Committee for Mental Hygiene, Inc., 
New York, N. Y., 
Director. 



Report of the 

Maryland Mental Hygiene 
Survey 

With Recommendations 



SURVEY REQUESTED BY 

The Baltimore Alliance of Social Agencies 
The State Lunacy Commission 
The State Board of Education 



Conducted under the auspices 
of the National Committee for 
Mental Hygiene, Inc., and a 
special advisory Commission 
appointed by Hon. Albert C. 
Ritchie, Governor of Maryland. 



u\ <\1^X 'n 






■ 

Maryland Mental Hygiene Commission 

President, Secretary, 

DR. F. J. GOODNOW, DR. CHARLES B. THOMPSON, 

President, Johns Hopkins Executive Secretary, 

University. Mental Hygiene Society of Maryland. 

DR. L. F. BARKER, Former President, National Committee for 
Mental Hygiene. 

DR. GEORGE E. BARNETT, Professor of Statistics, Johns Hop- 
kins University. 

MR. ROBERT BIGGS, President, St. Vincent de Paul Society, 
Baltimore. 

DR. EDWARD N. BRUSH, President, Mental Hygiene Society of 
Maryland. 

DR. WILLAM BURDTCK, Director, Public Athletic League. 

MR. ALBERT S. COOK, Superintendent, State Department of 
Education. 

DR. FRANCIS LEE DUNHAM, Psychiatrist, State Bureau of Labor 
and Statistics. 

DR. KNIGHT DUNLAP, Professor Experimental Psychology, 
Johns Hopkins University. 

DR. J. M. T. FINNEY, Member State Board of Education, Balti- 
more. 

DR. HENRY M. FITZHUGH, President, State Board of Education. 

MR. LEON C. FAULKNER, Superintendent, Maryland Training 
School for Boys. 

MR. CHARLES J. FOX, Board of Labor and Statistics. 

DR. ARTHUR P. HERRING, Secretary, State Lunacy Commission. 

MR. HOWARD C. HILL, Executive Secretary, Maryland Prisoners' 
Aid Association. 

MISS THEO JACOBS, Associate in Social Economics, Johns Hop- 
kins University. 

MR. GEORGE L. JONES, Executive Secretary, Henry Watson 
Children's Aid Society. 

DR. FRANK W. KEATING, Superintendent, Rosewood State Train- 
ing School. 

MR. LOUIS H. LEVIN, Executive Secretary, Federated Jewish 
Societies, Baltimore. 

MR. OGLE MARBURY, Chairman, State Board of Prison Control. 

DR. ADOLPH MEYER, Director, Henry Phipps Psychiatric Clinic, 
Baltimore. 

JUDGE JACOB M. MOSES, Board of Directors, Mental Hygiene 
Society of Maryland. 

DR. JOHN R. OLIVER, Psychiatrist, Supreme Bench of Baltimore 
City. 

MRS. EDWARD SHOEMAKER, President, Women's Civic League, 
Baltimore. 

DR. WILLIAM H. WELCH, President, State Board of Health. 

DR. HENRY S. WEST, Superintendent, Department of Education, 
Baltimore City. 

MAJOR WILLIAM B. WRIGHT, Director, Baltimore Alliance of 
Social Agencies. 

DR! HUGH H. YOUNG, President, State Lunacy Commission. 



a 

National GorotwHtf 8 

for yLmtBiBstim 

aUL 1 I 1930 



Survey Staff 

DR. THOMAS H. HAINES, Field Consultant, National Committee 
for Mental Hygiene, Director of the Survey. 

DR. WILLIAM BURGESS CORNELL, Physical and Mental Diag- 
nostician, New York State Board of Education, Director of the 
Survey November, 1920, to February, 1921. 

DR. EDITH MICHAELS, Psychiatrist. 

DR. CHRISTINE LEONARD, Psychiatrist. 

DR. ARABELLE J. FELDKAMP, Psychiatrist. 

MR. C. L. HULTGREN, Psychologist. 

MISS ELIZABETH GREEN, Psychologist. 

MISS MINA A. SESSIONS. Psychiatric Social Worker. 

MISS ELSA BELLE KRAUS, Secretary. 



hi 



"A campaign for mental hygiene is a 
continuous effort directed toward con- 
serving and improving the minds of 
people; in other words, a systematic 
attempt to secure human brains so nat- 
urally endowed and so nurtured that 
people will think better, feel better, act 
better, than they do now." 

LEWELLYS F. BARKER, M. D. 



]Y 



Contents 

Introduction .. vi 

Mental Hygiene in Maryland - - - 1 

State Hospitals for the Insane 5 

Dependents and Delinquents * 9 

The Juvenile Court of Baltimore City 13 

Maryland Training- School for Boys _ „ 19 

Maryland Industrial Training School for Girls 23 

St. Mary's Industrial School 24 

The House of the Good Shepherd 27 

Children's Homes 28 

Government Venereal Clinic, Baltimore _ 29 

County Almshouses.. 33 

County Jails - 35 

Maryland Penitentiary and House of Correction 38 

Mental Hygiene and Correction in Maryland 53 

Public School Surveys 58 

Mental Hygiene and Dependency _ „.. 57 

General Comparison of County Groups _ 62 

Group Intelligence Tests 64 

Psychiatric Examinations and Findings 66 

The Feebleminded Child and the Special School 67 

Dullards 70 

The Nervous or Psychopathic Child 71 

Mentally Defective Colored Children 72 

Mental Hygiene in Education 73 

Care of Mental Defectives in Maryland 76 

Epileptics in Maryland 78 

Summary » 81 

Conclusions 82 

Recommendations 91 

v 



Introduction 

It is hardly possible to set down on a single page all 
of the Maryland agencies to whom credit is due for the 
success of this survey. The Lunacy Commission and 
Governor Ritchie have furnished office space for our work. 
The Governor and the members of his Commission have 
been eager to help and have done all that was asked of 
them. Every officer of every institution and school visited 
has put forth most kindly co-operative effort to make sure 
of uncovering all the facts. The following agencies aided 
in forming a card index of mental defectives : 

The Jewish Children's Bureau 

Miss Strothers' Special Class in School No. 21, Baltimore 

The Frederick County Children's Aid Society 

Case Records of the Boys' Industrial School 

Case Records of the Baltimore City Juvenile Court 

The Henry Phipps Psychiatric Clinic 

The State Lunacy Commission. 

The Lunacy Commission Deficiency Survey, begun in 
1916 by Miss Jane Griffith, secured some important data 
which were placed at our service. Dr. F. L. Dunham's 
records at the Maryland Industrial Training School for 
Girls and the Maryland Training School for Boys served 
greatly to curtail our work at these institutions. 

Dr. Thompson's surveys of a children's home and of 
schools in Baltimore and Annapolis were contributed, and 
the Baltimore School Survey, by Professors Strayer, 
Trabue, and others, enabled us to come by a short route 
to large numbers of defectives in the Baltimore schools. 

From all these sources, we have come into possession 
of a trust from the people of Maryland. This widely 
voiced desire to know the facts and to have plans for 
dealing sanely and wisely with the situations disclosed 
puts a duty upon us which we feel to be at once a high 
privilege and a sacred charge. 



Mental Hygiene in Maryland 

The history of the public care of the insane and feeble- 
minded in Maryland is a long one. The Legislature, in 
1773, authorized the institution of four county poor- 
houses. In 1791 the Legislature was requested to author- 
ize the support of Mary Brown and Eleanor Love, a 
mother and daughter, in Prince George's County, both 
being "in a state of lunacy." Two years later support 
was asked for Rebecca Fowler, who had "convulsion fits 
and was in great measure deprived of the use of her 
senses." This same year, 1793, a father and mother 
appealed for the support of four helpless imbecile chil- 
dren unable to walk, to dress, or to feed themselves — 
Solomon, age 30; Sarah and Mary, 28; and Eliza, 26. 

In January, 1797, the Legislature passed an act "to 
encourage the establishment of a hospital for the relief 
of indigent sick persons and for the reception and care 
of lunatics." This act eventuated in the establishment 
of the Maryland Hospital, which was the third hospital 
to be established for the care of the insane in the United 
States. 

The Maryland Hospital, located on the present site of 
the Johns Hopkins Hospital, having become inadequate 
for the purpose for which it was designed, an agitation 
was made in 1852 for moving it to the country. At that 
time Dorothea Lynde Dix was in the midst of her active 
campaigning for better care of the insane. Miss Dix 
memorialized the Legislature of Maryland, pleading for 
a liberal appropriation for the site and building of this 
new hospital. She said in part: "The subject to which 
your memorialist solicits your candid attention and on 
which she urges early and effective legislation embraces 
from more than one point of view the field of social 
interests of the state of Maryland, reaching through 
every community and penetrating the seclusion of every 
family." These words of Miss Dix ring true for this day 
as well as for that. They show forth the woman's clear 
insight into matters of social organization and medical 
administration gained from an intimate acquaintance with 
the facts in the field. The Legislature of 1852 authorized 
the purchase of the site at Catonsville on which the pres- 
ent Spring Grove Hospital stands. Many delays inter- 



vened, among which the Civil War was most notable. 
Patients were transferred to Spring Grove October 7, 

1872. 

An act of April 7, 1886, created the State Lunacy Com- 
mission. A movement was then and there instituted for 
the complete state care of the insane in Maryland. The 
thirty-five years of the activity of this Commission have 
been notable in the progress of mental-hygiene adminis- 
tration in Maryland. 

In 1888, Dr. Richard Gundry, then Superintendent of 
Spring Grove State Hospital, was instrumental in estab- 
lishing what is now the Rosewood State Training School — 
an institution devoted to the training and custody of the 
feebleminded. 

In 1897, Dr. William Osier, then President of the Medico- 
Chirurgical Faculty, in addressing the 99th Annual Meet- 
ing, set up a notable landmark in Maryland's progress 
toward adequate public care of the insane and feeble- 
minded. Dr. Osier said in part: "When I say there are 
over 500 insane people in the almshouses and jails of this 
state I add that it is a reflection upon the intelligence of 
the people of Maryland. I say that because it is recog- 
nized the world over that insane people must be taken 
charge of by specialists and must not be herded together 
in jails and almshouses. They are the children of the 
state and should not be cared for by the ordinary physi- 
cian, who may be able to treat typhoid or scarlet fever 
well enough, but has no idea how to treat special diseases 
of the brain. I make no reflection upon the almshouses 
of this state, but I say that no physician who has not had 
special training is capable of treating lunacy properly. I 
might also say that it would save thousands of dollars to 
the state if all the insane were properly treated by spe- 
cialists." 

At this time steps were being taken to organize a second 
state hospital. A large farm was purchased in the beau- 
tiful rolling section of southern Carroll County and the 
Springfield State Hospital was opened March 8, 1898. 

The Twenty-third Report of the State Lunacy Commis- 
sion (1908) not only constitutes a landmark among the 
notable performances of this Commission and of its secre- 
tary, but is also a notable document among the records of 
the progress of the medical care of the insane. It pre- 
sents pictures of chains, rags, cells, and shacks used in 
the county care of the insane in Maryland in that day. It 
made a notable impression, and had no small part in 
achieving the excellent present facilities in the state. 



Legislative enactment provided for complete state care 
of the insane from and after January, 1909. Crowns- 
ville State Hospital was started with twelve working pat- 
ients March 13, 1911. The Eastern Shore State Hospital 
was started with twenty-four working patients December 
11, 1913. 

In the Twenty-eighth Report of the Lunacy Commission, 
December, 1913, the secretary notes visiting county asy- 
lums in Western Maryland with Dr. John S. Fulton, Secre- 
tary of the State Board of Health, at the request of 
Governor Goldsborough, and quotes from Dr. Fulton's re- 
port as follows: "I have reached the general conclusion 
that all of the almshouses should be cleared of their 
insane, imbecile, and idiotic inmates and that the care of 
the county poor should not be complicated in future by 
admitting cases of acute sickness or of epilepsy or of 
insanity." Dr. Fulton recommends the abolition of small 
almshouses and suggests the advisability of inter-county 
institutions where the dependent poor could have better 
care furnished at less cost than the people are now ex- 
pending for the wretched maintenance provided. 

In January, 1913, there was organized in connection 
with the State Lunacy Commission an after-care commit- 
tee. This was in charge of Dr. William Burgess Cornell. 
Subsequent reports of the Commission demonstrate that 
this work saved the state ten times its cost in careful 
placing out of patients from state hospitals. This work 
ofrew into the present Mental Hygiene Society, of which 
Dr. Charles B. Thompson is executive secretary. 

Average daily populations of the state institutions 
mentioned above for 1920 were as follows: 

Spring Grove State Hospital _ 709 

Spring-field State Hospital 1501 

Crownsville State Hospital 526 

Eastern Shore State Hospital 243 

Rosewood State Training School 688 

There are in the four state hospitals for the insane up- 
wards of 500 patients who are not insane, but are mental 
defectives. There is a considerable number of patients 
in these institutions who are epileptic. Proper provision 
for the non-insane epileptic and the non-insane feeble- 
minded would make room in the present state hospitals 
for the insane now harbored at county almshouses. 

The point of greatest pressure among the mental-hy- 
giene problems in Maryland is that of care for feeble- 
minded persons. The Rosewood School is in fact as well 
as in name a training school. It has not been designed 

3 



for the custody of adults. Feebleminded adults are 
really children and need custody. Social workers, relief 
agents, and correctional organizations and institutions 
all feel the need of organized facilities for caring for 
adult feebleminded, as well as for children, and for col- 
ored feebleminded, as well as for white; in fact, we might 
say that the problem of the defective delinquent is the 
cardinal mental-hygiene problem in Maryland. 

It was on account of this problem and its cardinal char- 
acter that the Baltimore Alliance appointed a committee, 
February 27, 1919, to ascertain what steps might be tak- 
en to relieve the situation. This committee, with the 
Lunacy Commission, early in 1920, invited the National 
Committee for Mental Hygiene to make a thorough sur- 
vey of the situation in Maryland. Later the State Board 
of Education joined in this invitation to the National 
Committee. Upon the assumption by Dr. Cornell of the 
direction of the survey, in November 1920, Governor 
Albert C. Ritchie took an active interest in the work. 
Governor Ritchie also broadened the scope of the sur- 
vey by requesting that Dr. Cornell should co-operate with 
the Lunacy Commission, the superintendents of state 
institutions, and the State Board of Prison Control in 
helping to solve some of the problems which he had re- 
ferred to these boards and persons. 

From the nature of the situations that led to our invi- 
tation, it is clearly to be seen that the task of this survey 
is a broad piece of social engineering. It was laid upon 
us to ascertain facts and to lay plans in accordance with 
the facts. It has been related of Mr. James J. Hill that 
he believed "that intelligent management of railroads 
must be based upon an exact knowledge of facts." He 
believed that no superintendent could be an effective 
superintendent nuless he knew the facts. A superinten- 
dent must know what it costs to haul a ton of freight a 
mile on his division each month and quarter and he must 
have the analysis of this cost in order to be in a position 
to effect economies and maintain service. These econo- 
mies could not be effected by guess work. It is equally 
true in such social engineering as this survey entails 
that we must have the facts. We must know the kinds 
of defects which are leading to various leaks and fric- 
tions in the social economy of a community; we must 
know how many there are of them; and we must lay plans 
to manage them in such a way as to diminish the friction 
to a minimum and prevent the leaks. It is the purpose 
of the survey to show how the state can care for its irre- 



sponsible adult children and its mentally sick persons so 
that they shall be as happy and useful as possible and 
shall be prevented from placing unnecessary burdens 
upon the rest of the people and upon their children. 

The survey was planned to study the involvement of 
mental-hygiene factors in social problems generally. 
Relief work, correctional work, and education have all 
come in for investigation. Several thousand children in 
the public schools have been included in the survey. It 
is evident that many of the problems which will arise in 
later life can be recognized and prevented by proper ex- 
amination of school children and suitable administration 
of prophylactic work during the educational period. In- 
stitutions for the care of dependents and delinquents, both 
children and adults, are doing their work in a fashion 
that would merit drastic criticism if they were railroads 
coming under Mr. Hill's scrutiny. This is not the fault 
of the institutions as such. The responsibility for their 
inefficiency is to be placed upon the community, for the 
community is not using the highest intelligence in the 
burdens which it places upon these institutions. The 
institutions are inefficient because they were asked to do 
work for which they were not designed. 

State Hospitals For The Insane. 

The four hospitals in Maryland have been happily lo- 
cated and the buildings are for the most part new. These 
are noteworthy points of excellence. Other points to be 
mentioned are the training schools for nurses at Spring- 
field and Crownsville, the special services for acute and 
new patients at Springfield and Spring Grove (though the 
latter is operative only for ex-service men), the "open- 
door" policy pursued at Springfield, the pathologist em- 
ployed at Crownsville, the culture of willows and the bas- 
ket-making industry at Spring Grove and Crownsville, 
and the building in process of erection at Spring Grove 
for the care of one hundred criminal insane. 

The average daily population of the four hospitals and 
the Rosewood State Training School for 1920 was 3,667. 
These same institutions in 1911 had populations aggre- 
gating 2,086. This notable increase of state care of the 
insane and feebleminded in ten years is due in large meas- 
ure to the constant activity of the Lunacy Commission 
and their secretary. It was a splendid achievement. 

The two most notable reservoirs of insane in the state 
outside of state care are the Insane Department at Bay 



View and the Sylvan Retreat in Allegany County. On 
June 27, 1921, Dr. Feldkamp found 78 insane persons at 
the Sylvan Retreat, and on June 30, 1921, I found 258 in- 
sane persons at Bay View. About 10 per cent of these 
336 persons are non-insane feebleminded. The state ap- 
propriates $2,000 a year to the Sylvan Retreat and 
$15,300 to Mt. Hope Retreat. 

The non-insane feebleminded in the four state hospi- 
tals, according to figures furnished by the Lunacy Com- 
mission in March 1921, number 516. The management 
of these non-insane feebleminded persons with the insane 
is not most desirable. The physician in charge of the 
insane should have constantly uppermost in his mind 
restoration to mental health. To be sure, proper occupa- 
tion is a very large factor in the treatment of the in- 
sane, and the farm life, which is a considerable part of 
the occupation for males at these state hospitals, is suit- 
able for the feebleminded. Nevertheless, separation of 
these classes would conduce to the effectiveness of the 
treatment of each. The feebleminded who are not in- 
sane should be placed in colonies. If this were done, 
it would at once make room for all the insane who are 
now at Bay View and the Sylvan Retreat and would make 
possible the shutting up of the last county asylum in 
Maryland. It would also take all the cases of active 
psychoses from the county almshouses throughout the 
state. 

In regard to medical service, we find only thirteen phy- 
sicians employed, including the four superintendents, 
whose time must necessarily be given largely to admin- 
istrative matters. Including the superintendents, we 
find an average of 230 patients for each physician from 
the average daily populations in 1920. 

The medical staffs were seriously depleted by our war 
activities. In Maryland, as elsewhere, many of these 
physicians have not come back. Better salaries are nec- 
essary if their places are to be filled. It is very desirable 
that there be more physicians to oversee the medical 
treatment of these patients. It is highly important that 
more investigative work be carried on and that a more 
scientific spirit should activate the medical activities in 
the hospitals. 

The reception service for acute cases designed for 
Spring Grove for which the Foster Clinic was erected 
should be put in operation. It is highly important that 
the buildings be completed and that this service should 
be put forward for the people of the metropolitan dis- 






trict of Baltimore. This constitutes an important ele- 
ment in closing up the Insane Department of Bay View. 

There is an urgent need for more trained nurses and 
attendants in these hospitals. It is highly desirable 
that the training schools in operation should be made to 
attract more men and women and that the wages offered 
them upon completion of their training should attract 
these specially trained psychiatric nurses to remain in 
the state service. 

Psychiatric nursing should comprise the immediate 
supervision of the employment of patients in the wards 
or wherever they spend their working hours. Of course 
the ultimate direction of this occupational therapy must 
be in the hands of a director of occupation under the 
medical director. We must never lose sight of the fact 
that occupation rs directed to therapeutic ends, and to 
make properly trained nurses feel responsible for the kind 
of therapeutic endeavor will be both economical for the 
institution and interesting to the nurses involved. It 
will bring them to a higher appreciation of their service 
to mental patients and will make them more useful in 
private practice. 

There is, in these Maryland institutions, a striking 
need for psychiatric social workers. The first work of 
the After-Care Committee eight years ago demonstrated 
the saving to be effected by this kind of work. Placing 
patients out of the hospital saves the state cost of board 
and lodging. Placing a patient in outside employment 
further contributes to the community the results of his 
work. The properly trained social worker put in this 
field will considerably cut down the present populations 
of these state hospitals. Maryland could profitably em- 
ploy a dozen such at once. They could more than save 
their salaries by the patients successfully paroled and dis- 
charged. Such service would benefit both the patients 
and the state. 

These social workers, moving about through commu- 
nities over the state in this parole work, would necessar- 
ily come in contact with incipient cases of mental disor- 
der. These they would naturally bring to the attention 
of the superintendent as liable to be his future patients. 
By adopting proper hygienic measures, the superinten- 
dent could often prevent hospitalization of these persons. 
The best possible means of organizing for this preven- 
tive work in mental medicine is the traveling or visiting 
clinic. In these clinics the physician and the psychiatric 
social worker would meet not only paroled patients, 



receiving their reports and noting their conditions, but 
they would also meet these incipient nervous and mental 
cases. Any person could come or bring another to such 
a clinic. There he should obtain the very best advice 
possible and this advice would often serve to abort an 
oncoming nervous breakdown. The medical staffs of 
the hospitals should be enlarged, social workers should 
be employed, and such clinics should be arranged for at 
stated intervals in the general hospitals in Baltimore and 
in the county towns throughout the state. 

In order to fulfill a pledge made by the Legislature 
more than a dozen years ago to take the care of the insane 
entirely into the hands of the state, it is not necessary 
to build greatly for the insane as such. The Foster 
Clinic should be completed and an administration build- 
ing should be erected at the Eastern Shore State Hospital. 
When the non-insane feebleminded and the epileptic now 
among the patients in the state hospitals for the insane 
are removed to institutions properly designed for them, 
increased attention to the scientific care and treatment 
of the patients in the state hospitals and these traveling 
clinics will further lighten the present populations, so 
that this pledge can be fulfilled and the last county asy- 
lum can be closed. By these same means all the insane 
can be taken from the county almshouses. 

A social worker in this situation is like the helper en- 
gine on a heavy grade. The helper engine accumulates 
momentum and saves the time of the crew and of the 
equipment of the train; and it works only on the part 
of the road where there are great demands for service. 
What the helper engine saves goes into the treasury. 
What the psychiatric social worker saves in the way of 
board and lodging and increased buildings and medical 
and nursing staffs remains in the state tieasury, but 
such social workers save what is hardly estimable in 
dollars and cents. They save accumulated human re- 
sources of the community every time they prevent a 
mental breakdown and every time they aid in prevent- 
ing the propagation of the unfit. 

An important item in connection with closing the In- 
sane Department of Bay View is the institution of the 
psychiatric service at Spring Grove. The half of this 
building now devoted to ex-service men, for which the 
government is paying liberally, should be augmented by 
the completion of the building and this should be put at 
the service of the nervous and mental cases originating 
in the Baltimore district. By means of clinics in the 



city hospitals, ambulance service and suitable legal ar- 
rangements for temporary commitment, this 250-bed 
hospital should be constituted a real sanatorium for ner- 
vous and mental cases in this district. 

It is desirable to find a way to adjust methods and rates 
of taxation so as to support the indigent insane of Mary- 
land wholly through the state treasury. The taxpayer 
pays for this support whether the county pays one-half 
or the state pays it all. If adjustments could be made 
whereby a state tax covered the whole expense for the 
care of the insane, the burden would be placed equally 
upon all taxpayers, and this arrangement would, at the 
same time, tend to secure an even higher grade of ser- 
vice. Such a plan of completely state-financed care of 
insane persons is the only workable plan of state care. 
While a part-county-pay plan is in effect, some counties 
hold back patients who should have state-hospital care. 

The state hospital for the insane should be linked up 
with all the other social-service agencies in a Human 
Betterment Program. An important part of this pro- 
gram is the prevention of the propagation of dependents 
and delinquents. The progeny of the feebleminded are 
not the only burdens for posterity which we can prevent. 
Epileptics, neurotics, and those suffering from various 
mental disorders present cases in which advice, and even 
stronger measures, should prevent propagation and im- 
prove the race. When the superintendents of state 
hospitals and training schools are linked up with the 
community through their psychiatric social workers and 
traveling clinics, they will feel, even more deeply than 
at present, their responsibility in this matter to the 
community and for the future. 

Dependents and Delinquents. 

No better introduction to the situation that led to this 
survey can be given than the presentation of the facts 
concerning the family tree shown in Chart 1. This fam- 
ily has made work for county jails, house of correction, 
soldiers' home, state hospital, training school for feeble- 
minded, training school for boys, and the Henry Wat- 
son Children's Aid Society. We find involved in the 
family history not only mental defects, but also alcohol- 
ism, immorality, shiftlessness, "queerness," attempted 
suicides, and tuberculosis, as well as infant mortality and 
still-births suggesting syphilis. 

A study of this family was partially worked up for 
the Lunacy Commission by Miss Jane Griffith in 1916. 



Miss Sessions has completed the field work and produced 
the charts presented. 

Looking at the lower line in the chart, we find the third 
fraternity of seven to be illegitimates. The last two of 
these died in infancy; the other five, four of whom are 
feebleminded, were brought to the care of the Henry 
Watson Children's Aid Society. Through the activity of 
.11 is society, three were committed to the Rosewood 
State Training School and the oldest boy to the Mary- 
land Training School for Boys. The mother of these 
children, the patient from whom this study starts, was 
bom in 1883. She is a feebleminded person of ten-year 
mentality with a speech defect. In 1916, when her chil- 
dren were referred to the Henry Watson Children's Aid 
Society, she was committed to a state hospital near the 
place where she was born. The fraternity of seven are 
supposed to have been fathered by a farm hand of some- 
what better mentality than her own. At the time of her 
commitment she was pregnant and it is reported that her 
own brother was responsible for her condition. Soon af- 
ter commitment she was delivered of a still-born child. 

After about four months in the state hospital, this 
woman was paroled to the home of a member of the board 
of managers to do house work. After a few months 
there she married a man of low intelligence. 

Her oldest boy, after three years in the Maryland 
Training School, at 19 married a girl of 16 who cannot 
sew or cook and who had no proper appreciation of her 
pregnant condition, having made no preparations what- 
ever for the child due in a few weeks. 

The second boy of this fraternity, born in 1906, seems 
to have a better inheritance that the others. He was 
placed in a foster home and had reached the sixth grade 
at 14. 

The oldest sister of the mother of these children, born 
in 1872, is the only one in her fraternity who went to 
school. She was also the most respectable.. She mar- 
ried and has been the subject of eighteen pregnancies. 
The first seven of these were miscarriages, the eighth 
died in infancy, and four of the remainder are feeble- 
minded like their mother. She is reported as apathetic 
and indolent, being a very bad housekeeper. Several times 
social agents have threatened to break up her home on 
account of the filthy conditions in it. 

These two sisters already described are the youngest 
and eldest of the fraternity of five. Of this fraternity, 

10 



O 



S ~T 



o 



CHART I 



D 



r.:::tf" 



5 



*•■ 5 5 5 5 6 6 



«'%i>r 



'•>?■ "•# a ?g- 



>n A n 




D"f - rn 



*j*'^]j 1 1 1_ 






4A^ A A A ^ A4 A A A #i 4i 44AAAA ii> A i 4AA A 



A A A 4 



.1894 b.!89t 



diphtheria S/>e> 



i B. R.sc~.o4 



CXi/i/ms Aid <5° 






vot, S.TS. 



.„ «,*«,» /W ^Soc/./J. 



Miss Sessions has completed the 
the charts presented. 

T.TMVL'imv ui tha lrk\x;ov linci in ih 




These two sisters already d 
and eldest of the fraternity o 



10 




the second, Charles, died in infancy with spasms. The 
third, George, born in 1875, is the accredited feeble- 
minded father of his youngest sister's eighth child, born 
in the state hospital. This man has no regular work. 
He loiters on the streets, "runs with common women," 
and drinks at every opportunity. 

The other sister, Annie, born in 1879, cannot read or 
write, though she went to school till she was 12. She 
impressed the social worker as gullible and childlike. Her 
home was found to be indescribably filthy. Her first 
child was fathered by a former convict. This child, her- 
self a defective, married a defective after her first child 
was bom. The first child died in infancy. Annie later 
married a low-grade illegitimate son of first cousins. Her 
husband works, but only a short time at a place. "He 
gets familiar and gets fired." This pair have had nine 
children, of whom the five eldest are feebleminded. They 
were placed in the care of the Henry Watson Children's 
Aid Society, which placed the boys at the Maryland 
Training School for Boys and the girls at Rosewood 
Training School. These three girls have been released 
by habeas corpus proceedings after about two years' 
training at the school. Annie, in explaining it, says that 
she "took them to the hippo-corpus." The eldest girl 
is very anxious to get married. 

Turning to the ancestry of this fraternity of five, of 
which Annie is a member, we find that George, their 
father, was born in Germany in 1841. After coming to 
Maryland, he was adopted as a neglected child. He never 
learned to read or write. He served in the Union Army 
during the Civil War and was honorably discharged. He 
seldom worked, living mostly on his pension. He was a 
very heavy drinker, was promiscuous in his sex relations, 
and it is generally reported by those who knew him that 
he was "not right mentally." George's parents kept a 
roadhouse in Maryland. Both were drunkards. His 
mother was killed in a drunken brawl. George himself 
attempted suicide twice, once with laudanum and once 
by hanging. He died in 1916. 

Eliza, the mother of these five, George's wife, was the 
eldest of fourteen children. She died of cancer at 48. 
She is described as a nervous person. She drank much 
in later life; two of her sisters died of tuberculosis, six 
died as infants, and the youngest, Si, is described as a 
shiftless sexual pervert, far below the normal in intelli- 
gence. The mother of his children has other illegitimate 
children and is poorly endowed mentally. One of her 

11 



children had such a dark complexion that the other chil- 
dren called her "nigger." The youngest child is a mental 
defective and she married a man with the same handicap. 
The eldest daughter has an illegitimate son of such low in- 
telligence that he is considered feebleminded. 

The neurotic taint came to Eliza from her mother. She 
is described as being "queer." This neuropathic taint, 
added to the unquestioned inferiority of Eliza's husband, 
George, has served to produce these extraordinary bur- 
dens for the state of Maryland, as indicated by the last 
generation depicted on the chart. 

Such a chart needs no comment. The social engineer- 
ing called for in handling such a stock is evident to all 
who see the type of beings that these circles and squares 
indicate. Proper engineering three generations back 
would have saved great burdens to the taxpayers today. 

Chart 2 presents a family of decided neuropathic taint. 
The father of the twelve children numbered in the lower 
line came from Switzerland. He himself had been in the 
care of the Phipps Clinic and the Spring Grove State 
Hospital for 20 years. He is the youngest of twelve chil- 
dren. Many of these have marked peculiarities. The 
three eldest were subjects of compulsory marriage. The 
second, a male, is alcoholic and neurotic and married a 
woman who developed a psychosis. Three of them died 
in infancy. The others all seemed to be psychopathic 
persons. 

The father of this fraternity of twelve which came 
from Switzerland was a heavy drinker and vulgar in his 
personal habits. He was a carpenter, was sometimes 
put in charge of work, but was very undependable. It is 
reported that he went for thirty years without holding 
a conversation with his wife, merely "snapping at her." 
He was seclusive. It is said that he would lie back of a 
stove like an animal, he was irritable and queer and at 
one time devoted himself to perfecting a perpetual-mo- 
tion machine. 

This man's wife, the mother of the fraternity of 
twelve which came from Switzerland, died of a left hemi- 
plegia at 72. She had deteriorated mentally. She wor- 
ried and fretted about her children. It is said that she 
was always very seclusive and peculiar in her ways. She 
often refused admission to her family when they came 
to visit her and would sit upstairs in her room refusing 
to come down to see them. Both this man and his wife, 
on immigrating to this country, completely severed their 
relations with their relatives. Little information con- 

12 




1900 b 1902 

Because of 



D- 



d 7SV«. 



O-r-TJ 



CHART I 



1847 
Left he™, />/•?£. 



Prohab/e A/sJ i>y 



Q 6 656 



r~ i 



b. 1882 < 
■S*^, Shvf-h 
Parson a //A, 



4. l9/«, bi889 /^ b.lStt 

>»;/d fSyc/?o-J< , I Am/e/y Ve u , 




:atlj/^ 



1907 b nil A/9/3 
Pecu/is^ Poll Do// 









b!88T 
ST. Ah r/ i I^ux/t-ia/ St. Mary's JTidas 



M* H VB /?ef*eaf- Vacant 



o 



ft""**/ 



D O 



obmshouu 



m.a. 8ty« 



to. 1913 b. 1911 ie™We, 



14 bi9/& b.19'8 b 192" 



ceming the family was obtainable. It was learned, how- 
ever, that this woman had a half-brother who was "al- 
ways like a little child." 

The mother of the numbered fraternity at the bottom 
of the chart was bom in Germany. She is described as 
of nervous temperament and below normal intelligence. 
She had a serious attack of neurasthenia after the birth 
of her ninth child in 1905. She has two first cousins who 
have been in orphan asylums and later at St. Mary's In- 
dustrial School. Both of them are alcoholic. One of 
them is insane, the other was a vagrant and has disap- 
peared. Her mother died of tuberculosis. 

This family presents social problems of a distinctly dif- 
ferent soil from the one portrayed in Chart 1. The 
need, however, for social engineering is evident. They 
constitute freight for society. They are hardly paying 
their way. 

The Juvenile Court of Baltimore City. 

An idea of the activities of this court is afforded by 
the following summary of dispositions of cases for the 
year 1920. (Table I). 



13 



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r-i Tf cm 



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15 



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OHH^OOH t^tH 

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t> CO 00 CO CO 
LC rt CM CM -^ 



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^t-COCOCSiH CO tH 
CM t— I CO CO 



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CO CO CO L> CM tH t^^h 
"tf iH CO CO. 00 



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O iO OS CO o 



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CO LO LO t> 



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PP K 

Is! 

BflS 

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.£ c c 

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— ' -t-> I— i 
OJ 0J oj 



14 



This presentation of the work of the court indicates a 
large amount of work with children. Nearly 50 per 
cent of the cases, it will be noted, are dismissed. We 
find, upon study of the court procedure, that many 
complaints of malicious, mischievous, and disorderly 
conduct are investigated by the "officer who stands at the 
door and are settled by him in the community." Of the 
cases actually brought before the court, some are "yel- 
low-sheeted" by the probation officer. This means that 
they are considered quite informally by the court, but it 
is impossible for the uninstructed spectator to know 
which cases are being acted upon formally and which in- 
formally. 

The probation officers make home investigations of all 
probationers except of those placed in homes under the 
protection of 'the court. Frequency of visits is a matter 
determined by the probation officers themselves. 

Records of cases are not always consulted when cases 
return to court. If the child denies having been in court 
oefore, the fact of such previous appearance may not 
come out until the case has been disposed of. Such a 
case was observed. Sometimes the court has reversed 
itself unknowingly and sentenced for a previous offense, 
when the child had already been placed on probation for 
a later one. Records are not in shape to be used most 
effectively. 

Psychiatric examinations are made only in problem 
cases referred to Dr. Francis Lee Dunham, psychiatrist 
for the State Bureau of Labor and Statistics. Dr. Dun- 
ham gives one day a week to this work. In order to 
demonstrate the desirability of having a regularly em- 
ployed psychiatrist, this survey made mental examina- 
tions of 99 cases. These cases were taken as they came 
to court; no selection was made. No opportunity was 
afforded for examination or private interviews except in 
the court room. The children were taken for the most 
part immediately after they had been before the court. 
It must, therefore, be borne in mind that the child was 
not in the best condition to exhibit himself, so that these 
examinations were hardly fair. 

On this account we availed ourselves of the kind offer 
of Dr. Dunham, to go over 104 cases which he had ex- 
amined. In reference to his cases, it must be borne in 
mind that they are special problem cases referred to 
him by the probation officers because they were prob- 
lem cases. Table II presents the diagnoses distributed 
by sex and race for each of the two groups. 



TABLE II. MENTAL DIAGNOSES OF TWO GROUPS OF BAL- 
TIMORE CITY JUVENILE COURT CASES, MARCH, 1921. 
(Problem cases examined by Dr. Dunham.) 







Total 






White 




Colored 






Cfl 






w 






m 




Diagnosis 


m 


13 




w 


13 




Cfi 


13 






03 




o 

Eh 


13 


a 


03 


0) 


s 


15 



Normal 12 

Dull normal 6 

Borderline mental de- 
fect 5 

Mental defect 10 

Character defect 24 

Psychopathic person- 
ality . 4 

Psychoneuroses and 
neuroses 2 



5 

7 
15 



15 
14 

10 
17 
39 



12 



5 

9 

23 



3 

7 

2 

5 

11 



15 
12 

7 
14 
34 



Total 63 41 104 60 30 90 



11 14 



(Unselected cases examined by survey staff.) 





Total 


White 


Colored 






m 






OT 






W 




Diagnosis 


w 


*3 




to 


^ 
d 




w 


"3 






13 




c3 

O 

Eh 




s 

fa 


O • 
Eh 




£ 

fa 


p3 
o 

Eh 



Normal 18 

Dull normal 

Borderline mental de 

feet 

Subnormal 

Mental defect 

Psychopathic person 

ality _ 



Total 78 21 99 58 



18 


3 


21 


14 


2 


16 


4 


1 


5 


26 


3 


29 


17 


1 


18 


9 


2 


11 


14 


3 


17 


10 


1 


11 


4 


2 


6 


8 


1 


9 


6 




6 


2 


1 


3 


9 


10 


19 


8 


3 


11 


1 


7 


8 


3 


1 


4 


3 


1 


4 









8 66 20 13 33 



The absence of character defects in our own 99 cases 
means that our examiners were directing their atten- 
tion, in this part of the work, primarily to intelligence 
rating. It does not mean that character defects were 
absent in this group. It is rather remarkable that 19 
out of 99 cases, unselected, proved to be feebleminded 
while only 17 of Dr. Dunham's problem cases were diag- 
nosed as mental defectives. Of course somewhat differ- 
ent standards of diagnosis may have been in the minds 
of the two groups of examiners. It indicates in general, 






16 



however, that feeblemindedness is far from being the 
only sort of mental handicap that brings children into 
the juvenile court. That there are nearly one- fifth of 
these children ivho are so handicapped in intelligence 
equipment that ive must call them mental defectives is, 
however, significant evidence of the importance that 
this court should organize with a\ psychiatrist in charge 
of mental- examination work and with facilities for 
im forming the probation officers and the court of the 
reasonable expectations of treatment. Such a psychia- 
trist should constitute an important aid to the court in 
the administration of treatment. The primary object 
of such a children's court is so to adjust matters that the 
child will avoid future difficulties. In order to achieve 
this end, it is most essential that the court should be 
informed in regard to the mind and character under con- 
sideration. The 39 character defects noted amongst Dr. 
Dunham's cases and the 10 psychopathic personalities 
found in the two groups constitute most important 
problems for such a psychiatrical examiner. The 3 
psychoneuroses of Dr. Dunham's group require the 
knowledge and skill of a person versed in mental medi- 
cine both for diagnosis and treatment. 

The importance of psychiatric examinations may be 
emphasized by two cases. 

1. Arthur G — was born August 1, 1903, in Balti- 
more, of Irish parents. He went to school from the age 
of 7 to the age of 14, spending two years in each 
grade up to the fourth. His parents both died of influenza 
in 1918. His elder brother was a vagrant; three younger 
brothers were placed in homes. Arthur was taken in 
succession by four kind-hearted neighbors. They found 
him a "most degraded and profane character." He worked 
but little, was ungrateful, quarreled, and cursed. He 
preferred to sleep in barns. He gambled, losing $75 of 
war-time wages with no concern whatever. He was 
brought to the Juvenile Court because he was not work- 
ing and was not in school. He could not be found for 
two months. When found, he was placed on probation 
in a job as rivet sorter at a shipyard at $20 a week. This 
job he could not hold. He was then sent to the Mary- 
land Training School for Boys. 

This boy at 16 had a mental age of 9 years and 
was diagnosed as of "low-grade intelligence with a poorly 
balanced instinctive foundation." Enough detail is pre- 
sented to demonstrate that this lad is headed straight for 
a career as lifelong offender. Only most skillful manage- 

17 



ment of him can prevent him from preying upon society, 
and likewise save society from the task of caring for him 
all his life as an offender. It would be cheaper and more 
rational to care for his training now and see what can 
be done to make him social. Our very best of mental 
medicine should be at the service of the court in guiding 
the care of such a boy. 

2. Theresa N — was born in Baltimore August 5th, 1905, 
the eighth of nine children, of parents born in Poland. 
Her father was a laborer and alcoholic. The three eldest 
children were married and away from home. The next 
three were dead. The other two had been in the Juve- 
nile Court. They were doing well on probation. Theresa 
spent IV) years in the first grade, IV2 in the second 
grade, and 41/2 in the third grade. She played truant 
and stayed out at night. Application was made for a 
w 7 ork permit, but she would not come for examination. 
She was brought to the Juvenile Court as a minor with- 
out proper care, though her mother was anxious to care 
for her. 

At 15 years, Theresa had a mental age of 9V;> 
years. Her character basis was "well-organized." She 
was put on probation and did well. Reinforcement of the 
foreign-born mother's authority was necessary to secure 
the social adjustment of the girl. It was important to 
ascertain that she had a good character endowment which 
made adjustment possible. Psychiatric examination 
was especially important in view of her educational his- 
tory. Had such an examination been made earlier, her 
educational history would have been different, and she 
would have been made a happier and more useful woman. 

This Juvenile Court lacks a detention home. There is 
no opportunity now for the detention of cases for obser- 
vation except in cells at the station houses or in the city 
jail. Cases held for transfer to institutions must be con- 
fined in station houses or jail in direct violation of the 
Juvenile Court Law. 

There are many instances of calling into action habeas 
corpus proceedings for the release of feebleminded chil- 
dren who have been committed by the Juvenile Court 
to the Rosewood State Training School and to correc- 
tional institutions. These actions have very frequently 
terminated in the unwarranted release of feebleminded 
children. It is desirable that the jurisdiction of this 
children's court should be made original and complete in 
all children's cases. The Juvenile Court should be made 

18 



a branch of the Supreme Court of the City of Baltimore. 
It would be desirable at the same time to make this 
children's court a court of domestic relations and as- 
sign to it all cases that have to do with the family. 
Placed on such a basis, with a well-organized probation 
department, with provision for mental examination as 
well as physical, and with a building wherein children 
could be properly detained, this court would secure and 
maintain the respect of the community and of the legal 
profession. It would be thus placed in a position to do 
most effective work in preventing children's cases from 
coming to court. And preventive work is the work 
that should count with the police and with the courts, 
just as it does with the doctor. 

Maryland Training School For Boys (White). 

Table III presents the diagnosis of 226 boys comprised 
in the survey of the Maryland School for Boys, May 
1921. The National Intelligence Tests were given to all 
boys of the fourth grade and higher. Boys lower in 
school were given the Haines' tests X. form, an adapta- 
tion of the Army Alpha Tests. With the results of these 
tests and the institution records, including Dr. Dunham's 
mental examination and diagnoses, the boys were classi- 
fied as stated in the table. It is to be noted that we have 
here a small number of normal boys — only 7 per cent. 
The 20 per cent dull are, however, to be considered as 
without any striking anomaly. There is a relatively 
small number of mental defectives. The definitely fee- 
bleminded constitute only 7 per cent and there are 5 
per cent of borderline intelligence. The most striking 
features of this analysis consist of the psychoneuroses 
and neuroses (18 per cent), psychopathic personalities (24 
per cent), and character defects (17 per cent). These lat- 
ter are not so anomalous as to be considered serious path- 
ologies. They are, however, exaggerations of emotion- 
ality, paranoid tendencies, and shut-in characters. The 
psychopathic personality is a definite warp in the direc- 
tion of mental disease. In many cases it is an exagger- 
ation of the storm -and-stress period normal to adolescence 
and is often due to faults in the home or the school, quite 
as much as to hereditary factors. 



19 



TABLE III. MENTAL DIAGNOSES OF INMATES, 

MARYLAND TRAINING SCHOOL FOR BOYS, 

LOCH RAVEN, MAY, 1921. 

Diagnosis Number Per Cent 

Normal 16 7.1 

Dull normal 46 20.4 

Borderline mental defect 11 4.9 

Mental defect 16 7.1 

Character defect 39 17.3 

Psychopathic personality 54 23.9 

Psychoneuroses and neuroses 41 18.1 

Mental disease or deterioration. 3 1.8 

Total 226 100.0 

The delicate problems of the development of person- 
ality are the problems with which this school has to 
deal. In the service of adjusting them, it is most im- 
portant to have the best information obtainable as to the 
nature of each. This school has been most fortunate in 
securing the service of Dr. Dunham as psychiatrist. His 
service on the staff constitutes a high point of excellence 
in the organization. 

To indicate more specifically the kind of problems the 
school is called upon to cope with, we include notes con- 
cerning two boys. 

1. Malcolm N , the older of two children, was born 

June 27, 1905. He had spasms during infancy, and at 
14 he was afflicted with encephalitis lethargica. He was 
out of school one year. He had made the fifth grade at 
14, after having been transferred many times at the 
request of his father. He was a disciplinary problem, 
and this was exaggerated after his illness, when family 
discipline relaxed entirely. 

Examined by Dr. Dunham, he registered a mental age 
of 12 years. His mother stated that he had always 
been pugnacious, resented authority, had been seclusive 
and had no particular friends. 

Because he had become so out of joint with schools, 
a position was found for him. He was discharged be- 
cause of impudence. He left a second position because of 
the heat in the room where he worked. He was com- 
plained of in the Juvenile Court as a "community nui- 
sance," being accused of beating little girls. Some 
months later he was accused of stealing and ran away 
from home. His father, who had hitherto taken his part, 
had him locked up. He was examined at the Phipps 
Clinic, where it was decided that the problem was an 






educational one, but of a special sort, and he was com- 
mitted to the Maryland School for Boys. 

Here he has attempted to run away four times. He 
succeeded once. On his return he was put in isolation, 
became violent, and tried to break windows and furniture. 
It has been necessary to keep him locked up practically 
all the time, and he has spent his time scheming and at- 
tempting to destroy property. 

2. Harry W , an only child, was bom January 5, 

1904. His mother is dead of tuberculosis, his father is 
alcoholic. Harry began having convulsions at 14, diag- 
nosed as idiopathic epilepsy. He went to school from 
6 to 14, repeating the first grade three times and 
the second twice. He reached the fourth grade. At- 
tendance was irregular. He had tried nine different jobs. 
Some he had left because he did not like them, and from 
others he had been dismissed on account of his seizures. 
He was complained of for stealing $25.00 from an uncle, 
for picking on smaller children, and for being cruel to 
animals. 

At 15V2 he had a mental age of 9.5 years. His men- 
tal deterioration, on account of epileptic seizures, was pro- 
gressive, though slow. He had had inferior intelligence 
from early childhood. Attempts on his own part and 
by others to get him a situation in which he could be suc- 
cessful failed both in Maryland and elsewhere. On being 
arrested for stealing, the psychiatrist whose advice was 
asked recommended his commitment to Springfield State 
Hospital. He was committed to the Maryland School for 
Boys. Here he has threatened violence to other boys. 
He is a dangerous subject and should not be in the same 
family with other boys at this school. Harry is an ex- 
ample of a kind of burden that should not be placed upon 
the Maryland school. Neither should he be placed in a 
hospital for the insane. He is the kind of boy for whom 
Maryland needs a hospital for epileptics. 

This school is much less heavily burdened with mental 
defectives than many other state schools of its sort. This 
is no doubt due in part to the vigorous policy of the man- 
agement in insisting that the children committed to their 
care should possess the capacity for rehabilitation. That 
there are only 12 per cent of borderline and feeble- 
minded boys amongst these 226, whereas many such 
schools have 25 per cent of such defectives, indicates 
a very wholesome state of affairs. Nevertheless, it is 
unjust that any boy so feebly endowed that there is no 
reasonable chance of his rehabilitation for autonomous 

21 



citizenship should be committed to the care of this high- 
class reformatory and educational institution. Their 
work is rehabilitation and where there is no sufficient en- 
dowment by nature to warrant the expectation of such 
development, the child should be sent to an institution 
for defectives. The 16 feebleminded boys now in the care 
of this school constitute a strong exhibition of the jieed 
in Maryland for a colony for defective delinquents. Such 
a colony could well be established as a part of the organi- 
zation of the Rosewood State Training School. 

The problem boys who are picked out for the special 
work of this school will, however, always present many 
cases of dullness and some borderline cases, and it will 
be necessary to have a cottage wherein these boys can 
be given such treatment as their peculiar limitations of 
endowment dictate. There will be other special cases, 
such as the psychopathic personalities and some sex per- 
verts, for whom a special disciplinary cottage will be 
mandatory. The present rooms used for ^confinement 
and disclipinary purposes, in the Administration Build- 
ing, are not in keeping with the splendid plan and morale 
of the institution. These persons must be separated on 
occasions for their own discipline, and some of them must 
be separated more or less permanently in order to leave 
the institution free to take the proper measures for the 
improvement of improvable cases. Privileges and lib- 
erties should be provided as boys develop to use them. 
The presence in a cottage of cases that are incapable of 
development interferes with the rehabilitation of the im- 
provable boys, since such cases cannot be granted the 
privileges that are necessary for the proper develop- 
ment of the majority of the boys. 

This institution is beautifully located on the hills above 
the Gunpowder River, affording the best possible oppor- 
tunities for physical and moral health. The buildings 
are of the cottage type, mission style of architecture, 
happily adapted to the purposes of the institution. They 
are kept clean, which is the first requisite incentive to 
the cleanliness of person and the cultivation of clean 
mental habits. The personnel is imbued with the spirit 
of expecting the best of everyone and is organized to 
secure wholesome reactions. All this goes to make over 
these boys in the quickest and most effective fashion, so 
that they shall constitute useful citizens of the state 
and shall live the happiest lives possible for them. The 
state appropriated $30,000 to the institution in 1920 ; the 
city of Baltimore and the counties pay $130 per year per 
ooy. The institution furnishes all the clothing. 

22 






Maryland Industrial Training School For Girls (White). 

The survey of the Girls' School was made by the same 
procedure as that outlined above for the Maryland Train- 
ing School for Boys. Similar results of analysis of the 
mental conditions are presented in Table IV. In each 
school 28 per cent were found to be normal or dull and 
over 40 per cent were either psychopathic personalities 
or had psychoneuroses or neuroses. It is to be noted that 
there are more of the psychopathic personalities amongst 
the girls. There are slightly larger numbers of cases 
of borderline intelligence and mental defect among the 
girls. This may mean that the management of the Girls' 
School fights less vigorously against the admission of 
feebleminded cases; or it may mean that the Rosewood 
Training School has less opportunity to take in girls than 
boys. However this may be, it is certainly most import- 
ant that the 16 girls, in this population of 71, who are 
so inferiorly endowed in intelligence should not continue 
to burden the rehabilitation work of this school. It is 
to be noted also that there are three epileptics amongst 
these girls. They constitute three good reasons for the 
establishment of a state hospital for epileptics. 

TABLE IV. MENTAL DIAGNOSES OF INMATES, 

MARYLAND INDUSTRIAL TRAINING SCHOOL 

FOR GIRLS, BALTIMORE, APRIL, 1921. 

Diagnosis Number Per Cent 

Normal _ _.... _ 10 14.1 

Dull normal _ 10 14.1 

Borderline mental defect _ 7 9.9 

Mental defect 9 12.7 

Character defect 1 1.0 

Psychopathic personality 21 29.6 

Psychoneuroses and neuroses 8 11.3 

Epilepsy _ 3 4.2 

Mental disease or deterioration 2 2.8 

Total _.. 71 100.0 

The institution is located in Baltimore on the site to 
which the Female House of Refuge was moved about 
1866. The grounds are very much circumscribed and 
necessarily walled in, and the buildings are old and ill- 
adapted to the purposes of the school. The girls are 
working on machines, making shirts for a contractor. The 
management is progressive, and when they move to the 
new buildings now in process of erection on the Woodens- 
burg Farm, this school will doubtless become one of the 
models of its kind. The state appropriated $70,000 for 

23 



land and $180,000 for new buildings in 1921. An appro- 
priation of $25,000 was made for maintenance, the coun- 
ties and the city of Baltimore paying $130 a year for each 
girl. The school is to be particularly commended for its 
thorough physical and mental examination of incoming 
girls, for the cleanliness of person and house, for its plan 
of a single room for each girl, and for its training of girls 
in sewing' and cooking. No doubt broadened educational 
facilities will come with more wholesome and happily 
adapted rural surroundings in the new location. A firm 
policy as to the necessary progress a girl should be com- 
pelled to make before being paroled would relieve the 
school of the many present short-time commitments. 
Any girl who needs the care of the Maryland School for 
Girls should be placed in such care until she is 21, as the 
law permits. 

St. Mary's Industrial School. 

St. Mary's Industrial School is a corporation, according 
to its charter of 1866, "to receive and train to virtue, in- 
dustry, and learning, orphans and other destitute boys 
who may be committed to its charge." Vagrants and 
boys of vicious and incorrigible tendencies have been pro- 
vided for by later acts of the Legislature. It is true, 
however, that only a fraction of the boys in the care of 
St. Mary's Industrial School are delinquents. Many of 
them are orphans or half-orphans and were placed in the 
school for education. The institution is in the care of 
Xaverian Brothers. It is directed by a board, five mem- 
bers of whom are appointed by the Governor of Maryland 
and five by the Mayor of Baltimore. Less than two-thirds 
of the boys come from the state of Maryland. The others 
are from 33 other states and some from foreign countries. 

Group intelligence tests — the author's A. and X. form 
adaptations of the Army Alpha Tests — were given to 
413 boys in March, as one means of selecting those of 
low-grade intelligence and some other special problem 
cases for more individual examination. As a result of 
these group intelligence tests, we find the weighted age 
coefficient of St. Mary's Industrial School, as compared 
with median age group scores of several thousand pub- 
lic-school children in Mississippi, Missouri and Maryland, 
to be .82. This means that the average St. Mary's boy, 
compared with white boys and girls in the public schools 
of these other states, has an intelligence rating of .82. 
Considering the large number of delinquents, this is 
about the expected level. These scores, arranged by 

24 



school grades, show the boys somewhat in advance of 
public school children of the same grade. The school 
is conservative in its advancement of the boys. Several 
boys of 13 and 14 years of age are found in the first 
grade. 

Table V presents the distribution as to numbers and 
percentages of the different diagnoses resulting from the 
mental examinations. We find a relatively small num- 
ber of mental defectives ordinarily classed as feeble- 
minded. There are slightly over 11 per cent of mental 
defectives and borderline cases. Some of these cases, 
however, are striking misapplications of the energies of 
these Brothers. It is not the intention that they should 
devote themselves to the custody of persons so feeble- 
minded that they never will be able to manage them- 
selves. One boy in the third grade is 37 years of age. He 
comes from another state; he has been tried outside sev- 
eral times, but will not behave himself. He is so feeble- 
minded that he cannot take care of himself with the lar- 
ger boys on the farm. There are several others as defec- 
tive as this boy, but he is the oldest. If the Brothers 
could be relieved of the care of these 61 feebleminded and 
borderline cases, it would be a wonderful relief to them 
and a great facilitation of their work with the more nor- 
mally endowed boy who is their particular problem. Only 
these Brothers and others who attempt to teach the fee- 
bleminded along with approximately normal children 
know fully the unfairness that results to both the defec- 
tive and the normal. 

TABLE V. MENTAL DIAGNOSES OF INMATES, 

ST. MARY'S INDUSTRIAL SCHOOL, 

BALTIMORE, APRIL, 1921. 

Diagnosis Number Per Cent 

Superior intelligence 12 2.2 

Normal 156 28.5 

Dull normal „. 160 29.3 

Borderline mental defect 28 5.1 

Mental defect 33 6.0 

Character defect 118 21.6 

Psychopathic personality 20 3.7 

Psychoneuroses and neuroses 19 3.5 

Endocrine disorder _ _ 1 0.2 

Total 547 100.0 

We find in this table, for the first time, a number 
classed as of superior intelligence. The superior, the 
normal, and the dull constitute 60 per cent of the popu- 

25 



lation. This superiority to the other institutions already- 
studied is doubtless due to the large number of merely 
dependent children. 

We find almost 22 per cent of character defects and 
about 7 per cent of psychopathic personalities or psychon- 
euroses and neuroses. The presence of such a percent- 
age of such character disorders and near approaches to 
mental disease offers a striking illustration of the im- 
portance for this institution of a psychiatric examination 
of every boy who comes into the school. Treatment 
could be much more skillfully administered were these 
diagnoses made prior to or upon admission. That such 
examination would serve to direct economically the at- 
tempt to bring to normal lines boys with character de- 
fects needs no emphasis. 

As an instance of the kind of boy who needs a thor- 
ough mental as well as physical examination, in order 
that the institution may give him a square deal, we may 
note Henry F — . He was not in the school at the time 
of this survey, but he had been there during recent 
months. He was born September 7, 1904, in Baltimore, 
of Irish parentage. He was the ninth of seventeen preg- 
nancies. His father is a laborer and alcoholic. He has 
threatened to kill Henry's mother and has recently de- 
serted her. She thinks he is losing his mind. Henry 
had 52 spasms in two days at 17 months of age. He had 
an attack of meningtitis at 2% years, with temporary 
paralysis of the right side. He is now subject to grand 
mat attacks. He started school at 7 and progressed one 
grade each year. He has been running away from home 
and staying for weeks at a time. For this he was sent 
to St. Mary's Industrial School by the Juvenile Court. 
He was allowed to go home after six months, and was 
sent back to the school in two months on account of run- 
ning away. A year later he was brought to court for 
turning street railway switches. He was examined at 
15V-> years of age. He had an intelligence coefficient 
of .65. More important than his mental rating, how- 
ever, were the other discoveries of the psychiatrist. He 
found that beside suffering from epileptic attacks, Henry 
was somnambulic, had eneuresis, was a voracious eater, 
and a masturbator. He cannot be induced to put forth 
any effort to correct these habits. As might be sup- 
posed, with such symptoms and habits, his instinctive 
life presented no hopeful ground for a better organiza- 
tion. He cannot be returned to St. Mary's on account 
of crowded conditions. He is an example, however, of 

26 



the kind of boy that St. Mary's should not be asked to 
care for. On account of his epileptic seizures alone, he 
should be cared for in an institution especially designed 
for treating epileptics. 

St. Mary's suffered from a disastrous fire April 24, 
1919. At the time of the fire, they had over 900 boys. 
As will be noticed in Table V, there were 547 comprised 
in this survey. A building campaign was on at the time of 
the survey. Two large dormitory buildings, with gym- 
nasium and swimming pool facilities, have already been 
completed. The building program contemplates devel- 
oping capacity for 1,500 boys. The boys are for the 
most pail confined to yards enclosed by high stone walls. 
Practically every boy spends a half of each day in school. 
Many of them receive excellent vocational training in the 
print shop and tailor shop. The print shop does excellent 
work, taking commercial jobs for outside parties. Abun- 
dant opportunity is afforded for play. The boys appear 
to be well nourished, and the attitude of the Brothers to 
them seems to be most kind. 

The House of the Good Shepherd. 

Only white girls are received by the Sisters. This is a 
walled institution in the city of Baltimore. Girls are 
received from outside Maryland as well as within the 
state. The girls are mostly delinquent and incorrigible. 
They are divided into junior and senior groups according 
to gravity of offense. They attend school each day and 
are trained in the arts fundamental to home-making. 

TABLE VI. MENTAL DIAGNOSES OF INMATES, 

THE HOUSE OF THE GOOD SHEPHERD, 

BALTIMORE, MAY, 1921. 

Diagnosis Number 

Xcrmal 24 

Dull normal 16 

Borderline mental defect 4 

Mental defect 22 

Character defect 25 

Psychopathic personality 5 

Psychoneuroses and neuroses 3 

Endocrine disorder 1 

Total 100 

The results of the survey are shown in Table VI. 
There is a conspicuously large number and percentage of 
normal girls and a like conspicuously heavy incidence of 

27 



mental deficiency. In the cases of these 22 mentally de- 
fective girls, it is clear that society should have prevented 
their delinquencies by an early recognition of their child- 
like lack of self-control. When adolescence comes, with 
its unfolding sex life, the feebleminded person must be 
guarded like a child. If society were properly organized 
for the care of the feebleminded, much of the work at 
present laid upon the House of the Good Shepherd would 
not come to its door; much individual suffering would be 
obviated and much expense would be saved to taxpayers 
and charity organizations. 

The 25 per cent character anomalies and the considera- 
ble numbers of psychopathic personalities and psycho- 
neuroses demonstrate the importance of psychiatric ex- 
aminations of these children and tY\e recommendations 
that would result therefrom. 

Children's Homes. 

Dr. Feldkamp visited Loafs Home at Frederick, May 
27. She found 17 girls under very guarded, almost clois- 
terlike care. Even their school training is given inside 
the institution. She found 14 of these children to be of 
normal intelligence and character organization, 2 of bor- 
derline intelligence, and one a psychoneurotic. This in- 
stitution could make a larger social contribution in the 
administration of its trust. Many things could be done 
to socialize these children more effectively. They should 
have the benefit of more complete medical and social an- 
alysis of their cases, with the advice and prescription that 
would result from such psychiatric investigation. 

Dr. Charles B. Thompson, Executive Secretary of the 
Maryland Society for Mental Hygiene, made a mental 
survey of the Hebrew Orphan Asylum of Baltimore in 
1920 by examining all their children at School No. 65. 
Of the 79 children seen, he diagnosed one as of superior 
intelligence, 37 (46.8 per cent) as of normal endowment, 
13 (16.5 per cent) as dullards, 24 (30.4 per cent) as sub- 
normal, 2 as of borderline intelligence, and 2 as being 
mentally defective. As is common with children's 
homes, the institution is burdened with large numbers of 
subnormal and dull children. Nearly 50 per cent of their 
charges were such. The population differed, however, 
markedly from many such institutions in various parts 
of the country in its very light burden of mental defec- 
tives — only 5 per cent, whereas 20 per cent or 25 per cent 
is very common. 

28 






The management of this institution has come to appre- 
ciate fully the value of medical science and especially of 
mental medicine. In their new work at their new loca- 
tions, they will provide good clinical facilities and high- 
class social service. Dr. F. L. Dunham is examining ev- 
ery child and they are prepared to provide the medical 
and social service indicated. 

Government Venereal Clinic at Mercy Hospital, 

Baltimore. 

Table VII presents the mental diagnoses by race and 
sex of 92 cases examined at the Government Clinic by 
Dr. Cornell, Dr. Leonard, and Miss Catherine F. Bell, a 
psychologist employed for this work. 



TABLE VII. MENTAL DIAGNOSES, GOVERNMENT VENE- 
REAL CLINIC, MERCY HOSPITAL, BALTIMORE, 
DECEMBER, 1920, TO MARCH, 1921. 





Total 


White 


Colored 






m 






w 






w 




Diagnosis 


OT 


75 




w 






w 










s 


. «8 

O 


75 


S 


o 
Eh 


75 


s 


o 
Eh 



Normal _.... 




15 

6 

"2 
1 


34 
2 

5 

4 
15 

3 

3 

2 


49 


Dull normal 

Borderline mental de- 
fect 


8 

5 


Subnormal 

Mental defect 

Psvchcpathic pel 
alitv 


son- 


4 
17 

4 


Psychoneuroses 
neuroses 


and 


3 


Mental disease or de- 
terioration 


2 



15 

4 



25 


40 

4 


4 

3 

12 


4 

3 

14 


3 


4 


3 


3 


2 


2 



1 1 
1 1 

3 3 



Total. 



24 ' 68 92 22 52 



16 18 



Of these 92 cases, 26 were under treatment for gonorr- 
hea, 48 for syphilis, and 13 for both gonorrhea and 
syphilis. 

Of the 17 diagnosed as mental defectives, 15 were fe- 
male and 2 male. This is about 8 per cent of the males 
and about 22 per cent of the females. Of the females, 
3 were colored and 12 white. Only 2 colored males were 
seen. These were both found to be dullards. There is 
a striking preponderance of normal intelligence endow- 
ment — 49 out of the total number of cases. Of these, 34 



29 



are females and 15 males — 62 per cent of the males, 50 
per cent of the females. The fact that there are near- 
ly 50 per cent of these cases manifesting some sort of 
mental abnormality, however, is very significant. It is 
very important to take into consideration in any cam- 
paign designed to rid the community of carriers and dis- 
seminators of gonorrhea and syphilis. It must be noted 
further that many of those who are put down as of nor- 
mal intelligence have a very perverted sense of respon- 
sibility and a very short-sighted view of their own self- 
interest. Some notes on cases will emphasize these 
points. 

Mary W — , born in Baltimore of Irish parentage, 21 
years ago, under treatment for gonorrhea and syphilis, 
had a varied experience in school, attending parochial 
schools and public schools, and spending some time in 
St. Mary's Orphan Asylum. She had three brothers, at 
various times in St. Mary's Industrial School. She her- 
self had also been in the House of the Good Shepherd. 
She did not get along well with her sister-in-law and the 
fact that she had no real home was a serious element in 
her development. She was referred to the clinic by the 
St. Vincent de Paul Society, after she had married a man 
who took her to his mother's .home to live and who was 
put down as a "market bum." She claims he is a sex 
pervert. She acknowledges being immoral with one man 
prior to marriage. The girl is of an emotional type ; she 
cries easily and she has poor judgment. In the test she 
made a mental age of 11 years and 5 months and was 
rated as of borderline intelligence. 

Nettis S — , a white girl of 17, born in Baltimore 
of American-born parents, was under treatment for both 
gonorrhea and syphilis. She had lost her parents when 
small and had been in the care of the Children's Aid So- 
ciety. She had run away from families where they plac- 
ed her. Two brothers had also run away and had been 
placed in the Maryland School for Boys. She had com- 
pleted the fifth grade in school at 14 years of age. At 16 
she was married. She admitted promiscuous relations 
before marriage. She lived with her husband three 
months. Since then she has been a sex delinquent with 
two men. She was brought in by the agent of the Inter- 
departmental Social Hygiene Board because a soldier ac- 
cused her of being the cause of his infection. She in turn 
claims that the soldier is the cause of her infection. This 
girl had a mental age of 11 years and 4 months and was 
rated as of borderline intelligence. 

30 






Hazel W — , colored girl of 17, born in Virginia of Vir- 
ginia-born parents, was under treatment for syphillis. She 
was living with a man as his common-law wife. She is a 
simple-minded negro girl, very talkative and supersti- 
tious. She has a record of completing the second grade 
at 14 years of age. She has been arrested twice for 
fighting. She was once sent to Bay View. She made a 
test age of 9 years and was rated as feebleminded. 

Florence L — was born August 28, 1901, in Cumber- 
land, Maryland. Her father was born in the United 
States, of German parentage. Her mother's ancestors 
were English. The mother herself was born in Mary- 
land. Her father was transferred late in life from a 
soldier's home in Virginia to St. Elizabeths Hospital (for 
the insane) at Washington, where he died in 1918. 
Florence's mother had nine children, of which she is the 
eighth. The first was still-bom, three others have died 
of spinal meningitis, according to the mother, one of ap- 
pendicitis after she was married, and the youngest of 
croup at 7 years. 

Florence walked and talked at the usual age. She had 
pneumonia at 1 year of age, which left her nervous. At 
8, she was ill with cerebrospinal meningitis. After this 
illness, she had to leam to Walk- over again. Her mother 
also says that her memory was impaired. She w T as sub- 
ject to spasms during childhood whenever she became ill. 
She left school at 14, having reached the third grade. 
Teachers told her mother that she was a defective. Since 
the age of 15, she has worked in a cotton mill at various 
times. "She takes bobbins off and earns $12 a week." 
She married an Italian chauffeur at 19, being at the 
time two months pregnant. Her husband is the source 
of her venereal infection. This child was not a delin- 
quent girl. She had no abnormal sex attraction. She 
seemed very well-balanced instinctively. She is slow 
and defective. The Family Welfare Association have 
been in touch with the family for 15 years. The wel- 
fare agencies of Cumberland also know the family well. 
None of these agencies has concerned itself with Flor- 
ence as a mental defective. She has a mental age of 9 
years. With her good instinctive balance, it is not nec- 
essarily institution care that is needed to prevent the 
kind of social havoc that is going on in this case. She 
should not have married ; she should not be a prospective 
mother; and she should not have contracted gonorrhea. 
She is a child and will always be. The community should 
arrange to care for her. 

31 



Rosina V — is the eldest of six children, all of whom 
were illegitimates fathered by at least four different 
men. She was bom in 1902. Her father, who has al- 
ways taken an interest in ht^ and who was never mar- 
ried, is a pleasant-mannered man who works as a watch- 
man. Her mother was very stubborn and hot-tempered. 
She ran away from home at 15, having reached 
the second grade. At that time she was pregnant. She 
then married another man than the one responsible for 
her condition. She was finally murdered by one of her 
paramours, who also shot himself. 

Rosina developed normally as a child. Her only sick- 
ness was measles, but she had a nightly eneuresis up to 
15 years of age. She was irregular in school, reaching 
the fourth grade at 14. She would not study. She 
was headstrong and disobedient. She never obeyed her 
mother, though she cheerfully listened to advice and 
orders. She was absent-minded. She has always been 
unappreciative of things done for her. She is not neat 
in her person or about her work. She is untruthful, 
lazy, never finishes a piece of work, wants to play all 
the while. After her mother's death, she was given into 
the care of a social agency, who had her committed to 
the Rosewood State Training School at 15. This was 
deemed wise both on account of her lack of school prog- 
ress and her uncontrolled sex instincts. After 2*/2 
years at Rosewood she was released through habeas 
corpus proceedings and placed as a maid in a private 
family by the social agency which had placed her at 
Rosewood. - In a few months she ran away and lived 
with her grandmother. During two months there she 
had six different jobs. She was a poor worker. She 
spent most of her time talking to men where she worked. 
She left her grandmother because she would not submit 
to her orders that she stay at home at night. She mar- 
ried a man on less than 24 hours' acquaintance and then 
discovered that he already had a wife. Three days later 
she married a second man whom she had met on the even- 
ing of her first marriage. Her 19-year-old husband, un- 
der treatment at a venereal disease clinic, is supposed to 
be the source of her infection. This girl has a mental 
age of 12 years, 6 months. She has a very poor charac- 
ter make-up which comes to her, as is seen, by the regu- 
lar avenue of heredity from her mother. On account of 
the poor character organization, rather than her endow- 
ment of native intelligence, it has been decided again to 
send her to Rosewood. At the time of her examination 

32 



she was held in a hospital awaiting a vacancy at the 
training school. 

County Almshouses. 

The following summary presents a list of the county 
almshouses visited during May and June , and the popula- 
tion of each: 

Allegany County Home _ 57 

Anne Arundel County Almshouse „.. 11 

Baltimore County Indigent Infirmary 35 

Montevue Hospital, Frederick County 101 

Montgomery County Almshouse 15 

Talbot County Almshouse _ 9 

Bellevue Asylum, Washington County 86 

Total - 314 

We also visited and inspected the 246 insane patients 
in care of Baltimore City at Bay View and the 88 insane 
at the Sylvan Retreat or Allegany County Asylum. These 
334 persons were all found to be insane and feebleminded. 
They do most emphatically merit better care, such as the 
state hospitals are giving. 

TABLE VIII. DISTRIBUTION OF MENTAL DIAGNOSES BY 

COLOR AND SEX OF THE POPULATION OF 

SEVEN MARYLAND COUNTY ALMSHOUSES, 

MAY AND JUNE, 1921. 





Total 


White 


Colored 


Diagnosis 










CO 






0) 






m 


a3 


l , 


w 


Cj 




w 


a 


, 




15 


s 




9 


s 




15 


s 






o 


o 


03 


o 


<u 


o 




S 


fa 


Fh 


§ 


fa 


fH 


§ 


fa 


H 



Normal 48 8 56 32 

Dull normal 14 5 1 

Borderline mental de- 
fect 2 2 

Mental defect 36 40 76 25 

Character defect 1 1 

Psychopathic person- 
ality 7 7 7 

Psychoneuroses and 

neuroses 1 1 

Mental disease or de- 
terioration 92 65 157 77 

Deaf and dumb 3 3 3 

Epilepsy 2 4 6 2 

Total 189 125 314 147 



7 


39 


16 


1 


2 


3 




2 
2 


30 


55 


11 


10 


1 


1 

7 




1 


50 


127 
3 


15 


15 


4 


6 







17 
2 

2 

21 



1 
30 



94 241 42 31 73 



33 



Table VIII presents the distribution of the 314 persons 
found in the 7 almshouses above noted according to men- 
tal diagnosis. It is perhaps startling to note that after 
these thirty years of agitation in Maryland for the state 
care of the insane, exactly one-half of this total popula- 
tion of 314 inmates of 7 county almshouses (not counting 
the insane asylums) are either now suffering from a 
mental disorder or are deteriorated mentally as the re- 
sult of a more or less active brain pathology in the past. 
Of these 157 mentally ill or deteriorated, 127 are white and 
30 are colored. The incidence, therefore, is greater among 
the whites. It is also slightly greater among females 
than among males. These 7 almshouses shelter about 
three-fifths of the total county almshouse population in 
Maryland. There are 10 other county almshouses. 
There are, therefore, probably some 260 persons in the 
county almshouses in Maryland who are either insane or 
bear the marks of previous brain pathologies. It is also 
interesting to note that 121 of these 157 'mentally dis- 
eased or deteriorated which we have found in the 7 alms- 
houses are in the three counties of which the Lunacy 
Commission, in 1908, reported that there were no insane 
persons in the almshouses. This indicates a radical 
change of affairs in the past 13 years. 

Turning to the line in the table dealing with mental 
defect, we find that 76 of the 314 persons are diagnosed 
as feebleminded. This constitutes about one-fourth of the 
total population and indicates that there are probably 125 
feebleminded persons in the 17 county almshouses in 
Maryland. These persons with the minds of children 
are most inappropriate wards of the county. The county 
almshouse is designed to care for aged indigent per- 
sons at the least possible cost to the taxpayer. It does 
not take measures to prevent hereditary defectives from 
begetting and bearing children. In fact, defectives are 
often encouraged to marry in order to save expense to 
the taxpayer. Ofttimes the almshouse constitutes a 
haven for the pregnant feebleminded woman. It shel- 
ters and feeds her while she bears and rears a child, the 
child that is destined, in the majority of cases, to be a 
public charge for life. The almshouse does not train the 
defective. In the almshouse she is far less useful to so- 
ciety and far less happy herself than she would be in a 
training school or colony. These statements about the 
unsuitableness of the almshouse for the feebleminded ap- 
ply equally to the congenitally deaf and the epileptic, of 
whom we find respectively three and six persons. 

34 



In these almshouses sheltering 314 persons, there are 
only 56 persons of normal mental constitution. There 
are probably, therefore, about 100 normal-minded aged 
and indigent persons in the 17 county almshouses of 
Maryland — not more than 150, certainly, who have not 
some serious mental defect or disease which makes them 
unsuitable persons to be cared for in the county institu- 
tion. With so small a number of persons to care for, it 
is certainly not economy to run these 17 different poor- 
houses in the counties of the state. Even if they were 
given proper care, this would be a most expensive process 
and wasteful administration. The counties could far 
better close up every one of the almshouses and have 
these normal-minded aged and infirm poor persons cared 
for in a state home and hospital for the aged. When 
the state cares properly for the mentally ill and the 
mentally defective, there will be so few cases in many 
counties that they will follow the example of Dorchester 
and Worcester and sell the county farms. For instance, 
Talbot County now owns and operates a farm of 150 
acres and a large farmhouse adequate to care for 20 peo- 
ple, for 9 inmates — 4 colored and 5 white — 4 of whom 
are mental defectives. They pay and maintain a sup- 
erintendent and his wife to care for these people ; another 
man runs the farm. The treasurer of the Board of Trus- 
tees of the Poor informed us that it cost the county 
$3,600 last year to run this institution. This of course, 
does not reckon interest on the investment the county has 
in the property, and the taxes lost through county own- 
ership. 

County Jails 

We visited the jails of 8 of the 23 counties of Maryland 
and found the populations in the jails as follows: 

Allegany County Jail 18 

Anne Arundel County Jail 11 

Baltimore County Jail 16 

Dorchester County Jail 

Frederick County Jail _ 7 

Montgomery County Jail „.. 6 

Talbot County Jail 

Washington County Jail 17 

Total _...._ ..„ 75 

All of these were males — 45 white and 30 colored. 
Table IX presents the distribution of mental diagnoses by 
race of these persons found in the six jails in which pris- 
oners were found. Twenty-three, or about 30 per cent 

35 



of these persons are of normal intelligence. Nearly 14 per 
cent are put down as dullards, 12 per cent are of border- 
line intelligence or definitely feebleminded, about 13 per 
cent have character defects, while about 21 per cent were 
diagnosed as psychopathic personalities. 

TABLE IX. DISTRIBUTION OF MENTAL DIAGNOSES BY 

COLOR OF THE POPULATION OF SIX MARYLAND 

COUNTY JAILS, MAY AND JUNE, 1921. 

Diagnosis Total White Colored 

Normal 23 12 11 

Dull normal 10 3 7 . 

Borderline mental defect 7 3 4 

Mental defect 2 11 

Character defect 10 8 2 

Psychopathic personality 16 14 2 

Mental disease or deterioration 4 3 1 

Epilepsy 1 ....... 1 

Endocrine disorder _ 2 11 

Total :..... - 75 45 30 

It is clear at once that these populations present very 
different mental problems from those of the almshouses. 
In fact, these jail populations show an unusually small 
percentage of mental defectives. In such a collection of 
delinquents, we commonly find more than 10 per cent 
mental defectives. The psychopathic personalities pre- 
sent the educational and psychiatric problems that should 
be solved for the judge by one competent in mental medi- 
cine. These problems come to the court from the schools. 
Were educational activities more adequately fitted to the 
needs of the individual child, there would be fewer of 
these unusual mental constitutions coming into our 
courts. 

Table X presents the distribution of these white and 
colored males found in the six jails according to age per- 
iods. The intimate relations of the school to the court are 
again indicated by this table. Four white boys are under 
15 years of age, amongst 75 county- jail prisoners; 
14 other boys are under 20. There are 48 of these 
75 persons who are under 30 years of age. This 
indicates that the county jail in Maryland is primarily 
an institution for caring for abnormal children and ado- 
lescents. 



TABLE X. DISTRIBUTION BY AGE AND COLOR OF 

POPULATIONS IN SIX MARYLAND COUNTY 

JAILS, MAY AND JUNE, 1921. 

Age Total White Colored 

Under 15 4 4 

15-19 14 13 1 

20-24 20 7 13 

25-29 10 6 4 

30-34 10 7 3 

35-39 10 6 4 

40-44 - _ 5 2 3 

45-49 1 1 

50 and over 1 1 

Total _....- 75 45 30 

With reference to the relation of the prisoner to the 
jail, we find 48 out of 75 persons awaiting trial. The 
fact that many of them found in June were to wait, till 
October for their trials is a serious criticism of the func- 
tioning of the circuit courts. Society should find a 
method of bringing to speedy trial such persons as it is 
necessary to arrest and hold for court hearing. 

We find two persons waiting to be transferred as 
insane, one to a county asylum and the other to a state 
hospital. We find two boys, 11 and 14 years of age, 
brothers, awaiting transfer to St. Mary's Industrial 
School. One prisoner was held as a witness, the remain- 
ing 22 had jail sentences varying from 4 days to 14 
months and for all sorts of offenses, from trespassing on 
the railroad and bootlegging to sodomy and operating a 
disorderly house. 

All will acknowledge that it is most unsuitable that in- 
sane persons should be lodged in jail under any circum- 
stances, and it is contrary to the law to retain children 
in jail. When one calls up a mental picture of some of 
these jails, the impropriety of such confinement of sick 
persons and children in them is greatly emphasized. The 
Maryland jail is an ancient structure with brick cells in- 
adequately provided with light and air. Many of these 
jails are in poor repair and are miserably kept. They are 
about as far from the ideal hospital or children's build- 
ing as could be imagined. 

County jails are generally considered by criminologists 
to be very unsuitable places in which to work the reform 
of the offender. These 22 persons found serving jail sen- 
tences are kept in idleness as well as in filth. The chances 
for their moral improvement and rehabilitation are very 
slight indeed while they are confined in such places. 

37 



The Maryland Penitentiary and House of Correction. 

The population of these two institutions are considered 
together, since they are both under the management of 
the State Board of Prison Control, and this Board has 
full power to transfer persons from either institution to 
the other. The House of Correction is situated at Jessup, 
20 miles southwest of Baltimore on the Baltimore and 
Ohio Railroad. In general, it is used for prisoners serv- 
ing short terms, but even this principle of distribution 
is not rigidly adhered to. The House of Correction is a 
typical prison building, situated on a farm and without 
outside walls. Some prisoners are worked on the farm, 
but most are employed in shops within the building. 
The Penitentiary is located in Baltimore. It is a walled 
institution. Both institutions have a contract system of 
labor, the principal industries of the House of Correction 
being the pants shop and the mat shop, while at the Peni- 
tentiary pants, overalls, and brushes are made and a 
foundry is operated. 

Public sentiment in Maryland has long demanded the 
abolition of the contract system in penal institutions. In 
1915, both political parties pledged themselves to the 
abolition of contract labor. The Legislature of 1916 cre- 
ated the Board of Prison Control and directed them to es- 
tablish a system of labor to supersede the system of con- 
tract labor. The Board reported in 1918 that it would 
be impossible to take any steps in this direction until 
acts were passed enabling the Board to terminate long- 
term contracts existing at both institutions. Such acts 
were passed and tested in the courts. As a result, all 
contracts were revised so that they could be terminated 
by either party at sixty days' notice. It still remains im- 
possible for the Board to abolish the contracts and em- 
ploy the prisoners on other work because the Legislature 
has not appropriated money for installing equipment and 
buying material. The institutions are run on the money 
earned by the prisoners in their work for the contractors. 

It is clear that there are problems of mental health in- 
volved in the consideration of what labor a given pris- 
oner had best be busy with. Considerable attention is 
devoted to the subject of the occupation of prisoners in 
a special report of the State Board of Prison Control of 
June 27, 1921. Governor Ritchie had especially referred 
this subject to the Board. He also referred it to this 
survey for any possible light we might be able to shed 
upon the situations and the problems involved. In our 



study of mental health in these two institutions, there- 
fore, we have endeavored not only to find out the kind 
of man in prison in Maryland, but also to study the pro- 
cess by which this kind of man can best be restored to 
his citizenship and to a useful place in community life. 
We have endeavored to study the occupations of the men 
in prison as well as their previous training in life in con- 
nection with the mental equipment of each and his ex- 
pressed interest in occupation. 

It is recognized that rehabilitation and restoration 
come largely through the formation and cultivation of 
habits of industry. There are men in prison who are 
so old that they offer little opportunity for reconstruc- 
tion. There are others so poorly endowed mentally that 
they are incapable of learning very much. Still others 
are afflicted with mental disease. For all of these, how- 
ever, whether ill or incapacitated by nature or through 
age, work of some kind is essential not only for develop- 
ing what capacity there is in the man, but for preserv- 
ing such ability as he already possesses. There is noth- 
ing more disorganizing than enforced idleness. The 
fairly normal-minded young adult is the most promising 
material upon which these institutions can work for the 
betterment of society. 

1. Distribution as to Sex. 

In these two institutions, the total populations studied 
were 1,386 — 877 at the Penitentiary and 509 at the House 
of Correction. Of these 66 were females, 37 women be- 
ing at the Penitentiary and 29 at the House of Correction. 
It seems likely that this relatively small number of women 
could be best handled by one or the other of these insti- 
tutions, and arrangements for such transfer are being 
made. There were 1,320 males — 840 being at the Peni- 
tentiary and 480 at the House of Correction. 

2, Distribution as to Age. 

Table XI presents the distribution of the male inmates 
of these two institutions according to five-year periods. 
This shows clearly that the business of the Board and of 
the superintendents of these institutions -is primarily 
with young men. Five hundred and sixty-six of these 
men are under 25 years of age — 62.6 per cent are under 
30 years of age. Of the total number only 14.3 per cent 
are 40 or over. 

39 



TABLE XL NUMBERS AND PERCENTAGES OF MALE 
INMATES OF MARYLAND PENITENTIARY AND 
HOUSE OF CORRECTION, CLASSIFIED ACCORD- 
TO AGE GROUPS, MAY AND JUNE, 1921. 



Age 


Number 


Per Cent 


Under 20 

20-24 

25-29 

30-34 


136 

430 

260 

159 


10.3 
32.6 
19.7 
12.0 


35-39 

40-44 , 

45 and over 

Unascertained 


135 

88 

100 

12 


10.2 
6.7 
7.6 
0.9 


Total 


1,320 


100.0 



3. Distribution as to Nativity. 

Table XII presents the distribution by nativity, total 
numbers and percentages, of the 1,386 inmates of these 
two institutions. Less than 50 per cent of them were 
born in Maryland. Neighboring states, such as Virginia, 
Pennsylvania, North Carolina, New York, District of 
Columbia, South Carolina, and Georgia, furnish the next 
largest quotas in the order mentioned. This is no unus- 
ual state of affairs with regard to penitentiary populat- 
ions. Most of our states have large numbers of offen- 
ders born in other parts of the country and some born in 
foreign countries. Some of these travel into the state at 
or very near the time of the offense. Some of Mary- 
land's problems have resulted from the recent northern 
migration of negroes. Many of the foreign-born in these 
Maryland institutions are sea-faring folk. Some have 
been apprehended attempting to smuggle drugs into the 
port of Baltimore. The Europeans come from all parts 
of the continent, but the largest contributions are from 
Russia (16), the British Isles ( 14), and Italy (12). 






40 



TABLE XII. NATIVITY OF INMATES, 

MARYLAND PENITENTIARY AND HOUSE OF CORRECTION, 

MAY AND JUNE, 1921. 

Nativity Males 

Maryland _ 586 

District of Columbia 32 

Virginia 160 

North Carolina 65 

South Carolina _ 31 

Georgia - 22 

Other South Atlantic States 30 

Pennsylvania 71 

New Jersey 11 

New York 33 

New England States 17 

East North Central States... 36 

West North Central States... 17 

East South Central States... 39 

West South Central States... 25 

Mountain States 5 

Pacific States _ 4 

Territorial Possessions 6 

Other West Indies, South 

and Central America 14 

Europe - 100 

Unascertained _.. 16 



Females 


Total 


Per Cent 


33 


619 


44.7 


3 


35 


2.5 


11 


171 


12.3 


2 


67 


4.8 




31 


2.2 


4 


26 


1.9 




30 


2.2 


3 


74 


5.3 


1 


12 


0.9 


2 


35 


2.5 


1 


18 


1.3 


2 


38 


2.7 




17 


1.2 


1 


40 


2.9 




25 


1.8 




5 


0.4 




4 


0.3 




6 


0.4 


1 


15 


1.1 


2 


102 


7.4 




16 


1.2 



Total _ 1,320 66 1,386 100.0 

4. Distribution According to Race. 

Table XIII shows the distribution of the 1,386 inmates 
of these two institutions according to race. Sixty per 
cent of them are native-born Negroes. This at once de- 
fines one of the important elements of the problem set the 
management of these institutions. These men and wo- 
men are as a general rule poorly trained in school and the 
experience of psychologists and psychiatrists in the Army 
has demonstrated the relatively low mental development 
of the Negro. 



41 



TABLE XIII. RACE OF INMATES, 

MARYLAND PENITENTIARY AND HOUSE OF CORRECTION, 

MAY AND JUNE, 1921. 

Race Males Females Total Per Cent 

African (black) 783 49 S32 60.0 

American Indian l 1 o.l 

Dutch and Flemish 2 1 3 0.2 

English 57 2 59 4.3 

Finnish 2 2 0.1 

French 4 4 0.3 

German 48 1 49 3.5 

Hebrew 25 25 1.8 

Irish 71 3 74 5.3 

Italian 19 2 21 1.5 

Japanese 2 2 0.1 

Lithuanian 5 5 0.4 

Magyar 4 4 0.3 

Roumanian 1 1 0.1 

Scandinavian 13 1 14 1.0 

Scotch 4 4 0.3 

Slavonic 37 37 2.7 

Spanish 3 3 0.2 

Welsh 2 2 0.1 

Mixed :. 170 7 177 12.8 

Unascertained 67 67 4.8 



Total 1,320 66 1,386 100.0 

Of the European stocks represented amongst the in- 
mates whose race was ascertained, it will be seen that 
there is a relatively small proportion of eastern and 
southern Europeans as compared with English, Irish, 
Germans, and Scandinavians. The larger number of the 
177 mixed and 67 unascertained are probably old Ameri- 
can stock who have little knowledge of the origins of their 
ancestors, and these, in turn, are from the races last 
mentioned. 

5. Distribution According to Mental Diagnoses. 

Table XIV distributes according to sex and race the 
various mental diagnoses resulting from our examina- 
tion of these 1,386 inmates. It also states the percen- 
tages of these various diagnoses found amongst the pop- 
lation. Only 14.6 per cent are considered normal; 28.3 
per cent are of the dullard type. Dullness is not a dis- 
ease, as explained already, it is simply a mental peculiar- 
ity, and the handicap is of such slight nature that it does 
not render one unfit for citizenship. The mental defec- 
tives and borderline mental defectives constitute 22.7 
per cent of the population. Minor character defects con- 

42 



stitute 9.2 per cent. Taking these and the normal and 
dull normals together, we have 52 per cent of the popula- 
tion without serious mental disorder or defect. The 17 
per cent of psychopathic personalities constitute problems 
of a serious nature handed over from the schools and 
correctional institutions. The 3 per cent of mental disease 
and deterioration, the epileptics, and the psychoneurotics 
constitute problems of serious import in which the aid 
of mental medicine should be sought. Wherever we find 
diseases associated with crime, the question of restoring 
health seems to be fundamental to rehabilitation of the 
character. This is most emphatically true in the case 
of mental disorder. It will be noted that the colored fur- 
nish much larger quotas to the total mental defectives, 
psychoneurotics, and mentally diseased than do the 
whites. 



43 



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44 



6. Distribution of Mental Diagnosis According to Age. 

Table XV distributes these 1,386 inmates according 
to diagnoses and age periods. The most outstanding 
feature of this table is the fact that more than half of 
the mental disease and deteriorations are in subjects over 
45 years of age. A great majority of the outspoken cases 
of mental defect, as well as of the borderline and dullard 
and normal types, follow the line already indicated by 
Table XI, in which 62.6 per cent of the total male popula- 
tion is shown to be under 30 years of age. Just about 
the same distribution with respect to age holds for the 
psychopathic personalities. The period from 20 to 24 
years of age constitutes the maximum for each one of 
these diseases. In fact, this is the period of life in which 
the incidence of crime is greatest for all the diagnoses 
mentioned, excepting the mentally diseased. 

Of the 148 minors under 20, it is worth while to call 
attention to the 25 diagnosed as mental defectives 
and the 16 diagnosed as of borderline intelligence 
in mental endowment. The whole group of 314 mental 
defectives and borderline mental defectives found in 
this population serves to emphasize the shortcomings 
of our educational system; but these boys and young 
men who have come to State's Prison, as it were, right out 
of the schoolroom, bring home to us most closely the im- 
portance of greater effort to steer these poorly endowed 
individuals while they are yet accessible to school influ- 
ence. When we can so organize our schools as to ap- 
peal strongly to the interests of the poorly endowed, we 
shall have smaller numbers of this class coming into cor- 
rectional institutions. 

The residue and remainder of mental defectives whom 
the school cannot socialize should be cared for and sub- 
jected to such further training as they are endowed to 
receive at farm colonies designed for defectives. Mary- 
land should have a farm colony for male delinquents. 
There should be one such for white males and one for 
colored. The problem of rehabilitation of the young man 
so defective that we call him a mental defective is so 
completely different from that involved in appealing to 
one of normal mental constitution that the penitentiary 
should be relieved of this work. We need the colony for 
defective delinquents for the same reason that we need 
the special school for defective children. The defective 
delinquent needs a training different from those of nor- 
mal intelligence and if he cannot be trained to live in the 

45 



community, his problem resolves itself into one of perma- 
nent custody, and this has never been conceived to be the 
business of the penitentiary for any save those who are 
serving life sentences. The primary business of the peni- 
tentiary is correction, and the mental defective, as such, is 
capable of little correction. 

7. Percentage Distribution According to Education. 

The statements of the prisoners themselves constitute 
the source of information as to education. Table XVI is 
presented as much to validate the sort of testimony in- 
volved in collecting these data as for the value of the facts 
presented. We present a percentage distribution accord- 
ing to whether the man said that he had had no school- 
ing, had completed the first, second, third, or fourth 
grade, some grade between and including the fifth and the 
eighth, or had entered the high-school course or college 
or professional-school course. We also present the per- 
centage distribution of those diagnosed as normal, and 
those presenting slight character defects. In another 
column we present the like distribution of those diag- 
nosed as mental defectives and borderline mental defec- 
tives. 

TABLE XVI. PERCENTAGE DISTRIBUTION OF INMATES, 

MARYLAND PENITENTIARY AND HOUSE OF CORRECTION, 

CLASSIFIED ACCORDING TO SCHOOLING. 







Normal, 


Mental 






Dull 


Defect and 


Schooling 


Total 


Normal, 
Character 


Borderline 
Mental 






Defect 


Defect 



No schooling* _ ' 16.5 11.4 31.5 

Completed 1 grade - 5.6 3.2 13.1 

Completed 2 grade 8.2 6.5 15.6 

Completed 3 grade 12.2 12.7 14.6 

Completed 4 grade 14.0 15.7 10.2 

Completed 5 to 8 grade 30.4 38.2 8.3 

High School 5.6 6.4 

College 2.3 2.1 

Unascertained 5.3 3.9 6.7 

Total - 100.0 100.0 100.0 

• Includes also those who did not complete the first grade. 



It is interesting to note that only 8 mental defectives 
claim to have completed a grade above the fourth. It is no 

46 



unusual thing to find a feebleminded child in the fifth 
grade, though it is a criticism of the system of promotion 
when a definitely feebleminded person is allowed to pass 
the fourth grade. Borderline cases may readily be found 
in the sixth grade or even higher — in fact feebleminded 
persons are found in high schools. Of these defectives, 
235, by their own statements, failed to get beyond the 
third grade, 99 of whom either never went to school or 
failed to complete the first grade. On the other hand, 
of the relatively normal individuals, only 34 per cent 
failed to get beyond the third grade, and only 11.4 per 
cent never went to school or failed to complete the first 
grade. Many of these are such extreme dullards that the 
school, as organized, makes little or no appeal to their 
interests. 

In fact the poor education of these 1,386 persons raises 
in one's mind most seriously the question of how much 
less the work of the Penitentiary might have been if the 
schools had properly taken hold of these persons when 
they were children. Two hundred and twenty-nine of 
them never went to school, or failed to complete the first 
grade, 77 claim to have completed the first grade only, 
113 others to have finished the second grade, 169 the 
third, and 194 others the fourth. We know well that 
reading, writing and arithmetic cannot keep one out of 
the penitentiary. We also know that every competent 
educator conceives his business to be the training 
of character and the making of citizens. No school 
could guarantee its product against antisocial conduct, 
but the school constitutes society's means of socializing 
the individual. These figures emphasize the educational 
problem as involved in preventive work which would save 
the expense of such institutions, to say nothing of other 
expenses involved in property loss, loss of life, and cost 
of apprehending and convicting criminals. At the same 
time, prevention of the offense would have saved the 
offender to productive activity in legitimate industry. 

8. Distribution According to Offenses. 

Table XVII distributes the 840 male inmates of the 
Penitentiary according to the offense committed. These 
are the more serious offenders, and perhaps for this rea- 
son their offenses are more easily classified in a concise 
way. In the House of Correction, we find other offenses, 
such as trespassing, disorderly conduct, having in pos- 
session or selling drugs and alcohol, carrying concealed 
weapons, and vagrancy. 

47 



TABLE XVII. OFFENSES OF MALE INMATES OF MARYLAND 
PENITENTIARY, BALTIMORE, CLASSIFIED ACCORD- 
ING TO MENTAL DIAGNOSES, JUNE, 1921. 



Diagnosis 





i ■ 

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Normal 129 98 

Dull normal 216 126 

Borderline men- 
tal defect 59 40 

Mental defect 85 43 

Character defect... 99 73 

Psychopathic per- 
sonality 174 118 

Psychoneuroses 

and neuroses 49 26 

Epilepsy _...._ 1 1 

Mental disease or 

deterioration 28 11 

Total _ 840 536 



4 
12 

7 
14 

7 

13 



61 



5 
19 



11 
5 



15 
53 

10 
17 
11 

31 

14 



12 



51 163 



12 



2 

1 3 

1 

2 Z... 
2 2 
1 2 



These inmates are classified according to mental diag- 
nosis and crime of which convicted. Crimes of acquisi- 
tiveness constitute 64 per cent of the total. Sex offenses 
constitute about 7 per cent; assault with intent to 
kill about 6 per cent; manslaughter and murder nearly 
20 per cent; bigamy nearly 1.5 per cent; and arson and 
other offenses each about 1 per cent. A conspicuous 
point in this table is that nearly half of the cases diag- 
nosed as mental disease or deterioration are convicted 
of manslaughter or murder. Twenty per cent of the 
mental defectives are murderers and 17 per cent of bor- 
derline mental defectives are murderers. Conspicuous 
amongst the crimes of the mental defectives are the 11 
assaults with intent to kill and the 14 sex offenders, the 
latter constituting about 16 per cent of the total number 
of mental defectives. While dullards furnish a higher 
percentage of murderers, they have a much lower percent- 
age of sex offenders. Those who are of normal intelli- 
gence furnish lower quotas for both these classes of 
crimes. The psychoneurotics and neurotics furnish a 
large quota of murderers and a very small quota of sex 
offenders. Crimes of acquisitiveness constitute the 
largest quota from the list of those so diagnosed. 



48 



It is clear that proper attention to the care of danger- 
ous feebleminded persons would prevent many of the 
serious crimes in Maryland. Likewise, more careful at- 
tention to the needs of those afflicted with mental dis- 
eases and psychoneuroses would diminish the mortality 
of the human race and save work on the part of the cor- 
rectional institution. 

9. Recidivism. 

Table XVIII distributes 1,386 inmates of these two in- 
stitutions according to their mental diagnoses and the 
number of sentences with which each man is credited. 
It must be borne in mind that these data concerning the 
number of sentences are obtained from the men them- 
selves and from the records of the institution. 

'TABLE XVIII. NUMBER OF SENTENCES OF INMATES, 
MARYLAND PENITENTIARY AND HOUSE OF CORRECTION, 
CLASSIFIED ACCORDING TO MENTAL DIAGNOSES, 
MAY AND JUNE, 1921. 

One Sen- Two Sen- Three Four or Unascer- 
Diagnosis Total tence tences Sentences More tained 

Normal 203 ' 143 33 19 4 3 

Dull normal 392 256 75 39 13 9 

Borderline 
mental defect 151 100 36 8 2 5 

Mental defect... 163 98 40 9 10 6 

Character de- 
fect 128 73 29 16 9 1 

Psychopathic 

personality 234 122 43 33 28 8 

Psychoneuroses 

and neuroses 73 42 21 4 3 3 

Epilepsy 3 2 1 

Mental disease 
or deterior- 
ation 40 19 13 3 3 2 



Total 1,386 855 291 131 72 37 

There are 1,349 inmates concerning whom these facts 
were ascertained. Of these 63 per cent claim to be serv- 
ing their first sentences; 22 per cent their second sen- 
tences ; 10 per cent their third sentences ; and only 5 per 
cent their fourth or more sentences. In short, there are 
only 37 per cent who are thus shown to be repeaters. 
Turning to the line of mental defect, we find only 38 per 
cent of these who are repeaters. About 28 per cent of 
the normals have likewise served more than one sen- 
tence. There seems to be no partiality in favor of any 

49 



one of these diagnoses in regard to the distribution of the 
repeaters. The evidence of this study is negative so far 
as regards correlation of offense and lack of intelligence. 

10. Occupation of Inmates of the Maryland Penitentiary 
and House of Correction, 

In order to study the problems of the occupation and 
training of these populations, we made careful inquiries 
as to the previous training of each man. We inquired 
as to what had been his occupation in detail, the num- 
ber of years he had been self-supporting, whether or not 
he was regularly employed, irregularly employed, did 
odd jobs, or no work at all. 

Of the 1,320 men, we find that 720 of them have so 
many occupations reported that it is impossible to state 
for each what his occupation really is. Of course, this 
might be indicative of versatility of talent, but the pre- 
sumption in the case of the kind of man we find in the 
penitentiary is that it is indicative of irregularity of em- 
ployment and a symptom of the general incapacity of 
the individual to fit into his environment. It is reasona- 
ble to conclude that, for the most part, these 720 men are 
untrained. It is also reasonable to conclude that this 
diversity of occupation is further evidence of the indi- 
vidual's failure to fit. Of course his presence in the in- 
stitution is evidence in this line. 

Twenty others frankly stated that they had no occupa- 
tion at all, and 10 were unascertained. This leaves us 
about 500 men with stated occupations. One-half of 
these we find to be laborers, farm laborers, and farmers. 
These men are occupied in work for which no training is 
required. Probably this represents the state of the 750 
of diversified occupations and "no occupation" referred 
to above. 

About one-third of these 500 men we find to have a 
small amount of training. They work at such occupa- 
tions as waiter, sailor, chauffeur, clerk, miner, and railway 
worker. 

Only about one-sixth of these 500 men — 72 out of the 
whole population of 1,320 — claim to have worked in oc- 
cupations that require definite training. In this list we 
have barbers, bakers, tailors, blacksmiths, engineers, car- 
penters, painters, electricians, and shoemakers. 

This pictures the relatively untrained human material 
— over 60 per cent of it under 30 years of age, and a large 
percentage of it afflicted with mental defect or definite 

50 



mental disease — with which the authorities of these in- 
stitutions have to deal in their endeavors to restore these 
men to society with personalities so developed and re- 
developed that they will contribute to society rather than 
act again in antisocial ways. 

11. Occupation in the Institutions. 

At the House of Correction, as already mentioned, 
there is a farm upon which several of the men are em- 
ployed. According to the statements we have obtained 
from the men, 28 work on the farm. Possibly larger 
numbers are employed at some seasons of the year. The 
other employment at the House of Correction are the 
mat shop and the pants shop. In the latter men cut 
and sew on power machines trousers and overalls for the 
contractors. 

At the Penitentiary the occupations are: (1) foundry; 
(2) brush factory; (3) pants factory; (4) road-con- 
struction gangs. Of course many men are employed in 
work about the institution. Much of the clerical work 
and janitor work, both inside and outside the building, 
are in the hands of the prisoners. They likewise do the 
kitchen and dining-room work entirely. 

12. Preferred Occupation. 

A conscientious attempt was made by the survey 
staff to ascertain what each prisoner was interested in 
learning to do. It is naturally to be expected that the 
low-grade individual will have little interest in work of 
any kind, and it is not to be expected that he could 
make an intelligent choice of occupation. It is likewise 
true that many offenders of average endowment lack 
interest. They really do not want to do anything. That 
is part of the character defect that has made them anti- 
social. We are, therefore, not surprised to find the ex- 
pressed choices to lie along the lines of opportunity of- 
fered in the institution. The man who is in the mat 
shop wants to be in the pants shop and vice versa. The 
man who is in the shop wants to be on the outside. Any- 
thing for a change! Intelligent choices were rarely 
made* when the man was asked what he was most inter- 
ested in doing. Some frankly said that they wanted to 
do nothing. 

It is a fundamental matter of mental hygiene that the 
beginning of rehabilitation with such a man consists in 
stimulating his interest in some kind of occupation. He 
cannot be a real human being without a desire to accom- 

51 



plish something. While he lacks such a desire, he is not 
in a condition to be discharged, no matter if his sentence 
has expired. 

It is important to have in the correctional institution a 
variety of occupations, so that the native ability and in- 
terest of every man can be appealed to — so that some- 
thing* can be found for each man to do which he will work 
at with a will. This calling out of his will in some con- 
structive effort constitutes the first step in the making 
over of his personality. It is very desirable, too, to have 
a plan of occupation whereby additional responsibility 
can be given to each man as he arrives at the state of his 
development which warrants his assumption of more 
control ofi his activities. For instance, at a walled insti- 
tution in Ohio, several hundred acres of farm land are 
operated by inmates who have shown themselves worthy 
of trust outside the walls. The farm work is done en- 
tirely by men who have pledged themselves and their 
honor to work out from under guard and show that they 
are worthy of the trust reposed in them. The farm 
work is made a species of "parole on the premises." 

Where there has been some previous training, it is highly 
important to utilize this training in further efforts to so- 
cialize the individual. Also, it is undesirable to put a 
man to work, during the time he is serving his sentence, 
at a trade which it is hardly possible for him to pursue 
in the community. These sewing-machine operators in 
both institutions will, very few of them, have opportunity 
to pursue such work in the outside world, even if they 
so desire. In the total population of 1,349 male inmates, 
we find only 10 who claim to have been tailors and gar- 
ment makers before admission to the institution, and yet 
more than one-third of these men work on sewing ma- 
chines every day; and the probabilities are small that 
more than a score of them will pursue such work upon 
discharge from the institution. There is no spirit of 
learning a trade. It is simply the performance of task 
work. It is rendered in the spirit of a task, not in any 
sense viewed as an accomplishment. 

Again, it is to be borne in mind that many of these 
men are unfitted by native endowment to work at such 
tasks with profit to themselves and others. Many of 
these men working on sewing machines are really far 
more useful both in and out of the institution as farm 
laborers. The work on road construction and that in the 
foundry at the Penitentiary are very suitable occupa- 

52 



tions for the dullard type incapable of further develop- 
ment and training for more skilled occupation. 

It is important, when the opportunity is afforded by 
adequate appropriation for the purpose, to develop in 
these institutions a sufficient variety of occupations to 
afford scope for the development of skill in every man 
who comes in to serve time. It is important, in allotting 
the man to his work, to study his own interests and to 
watch these interests develop as his personality finds ex- 
pression in his work. The termination of an indetermin- 
ate sentence will usually come when one has become so 
interested in doing something useful that there will be 
little or no tendency to drift again into antisocial con- 
duct. 

Mental Hygiene and Correction in Maryland. 

The student of mental hygiene looks at these institu- 
tions from the point of view of social engineering. He 
inquires what is their work and in what way they are 
serving the state. 

Just as the insane are no longer regarded as possessed 
of the devil, but are considered as sick persons and treated 
in hospitals, so, in recent years, we consider criminals as 
in no wise different from the rest of us except in degree 
of socialization. The same instincts and emotions under- 
lie the conduct that we consider antisocial and the con- 
duct of the socially responsible individual. The busi- 
ness, therefore, of the reformatory is to find out how 
these emotions and instincts have been organized into the 
character of the offender to make him antisocial, and to 
seek to remold or rehabilitate his personality. By this 
process, he is converted into an asset instead of a liabil- 
ity. The most serviceable penitentiary or reformatory 
is, therefore, the one that can most speedily make this 
analysis and effect this rehabilitation. 

Of the 1,386 individuals studied in the Maryland Peni- 
tenitentiary and House of Correction, only 66 are women. 
Numerically this is a small part of the work of these in- 
stitutions, however troublesome some of the individual 
problems may be. We have observed that upwards of 
60 per cent of these inmates are under 30 years of age. 
This emphasizes the educational character of the correc- 
tional work. Sixty per cent of these inmates are native- 
bom Negroes. This calls attention to the large number 
of relatively low-grade intelligence endowments with 
which the institutions have to deal. The fact that large 

53 



numbers of the remaining 40 per cent are of races from 
western and northern Europe presents a hopeful aspect 
for this reformatory work. 

It is significant that there are only half of these men 
and women concerning whom we can say, after study, 
that they are without serious mental disorder or defect. 
Of these, over 100 are diagnosed as having minor char- 
acter defects, and nearly 400 as dull in intelligence en- 
dowment. Of the other half who have serious mental 
defects, about 300 are diagnosed as mental defectives, 
over 200 as psychopathic personalities, and upwards of 
100 are epileptics, or have psychoneuroses or definite 
mental diseases or deteriorations. This situation is a 
very complex one for the educator and trainer to deal 
with. It makes the penitentiary a very special kind of 
school. Each problem is an individual problem. 

These various kinds of problems are not distributed 
to various age groups, nor do we find repeaters distribut- 
ed predominantly in any one of the various kinds of 
mental defect. These men are, on the whole, very poor- 
ly educated, as we would expect from the large numbers 
of feebleminded and dullard individuals. The analysis 
shows also most serious and dangerous crimes to be com- 
mitted by mental defectives, emphasizing the need of pro- 
per care of persons of defective intelligence. The feeble- 
minded are indeed sources of danger to the community 
because of their extreme pliability and suggestibility. 

The occupational training of these offenders in the Peni- 
tentiary and the House of Correction is as poor as their 
school training. Very few — less than 100 — of the total 
number have attained any skill in their work. The occu- 
pations in the institutions give little opportunity for de- 
veloping skill or useful habits of industry which will serve 
to place the man in productive lines when he is paroled or 
discharged. Very small numbers of these inmates have 
any intelligent interest in making more useful persons of 
themselves. Properly diversified occupations constitute 
the fundamental need in these institutions. 

The Penitentiary is at present making definite progress 
toward the goal of a modern correctional institution. The 
morale of the men is good. The Welfare Club — a contri- 
bution of the present warden — is proving of great value 
in giving the men outlook and inspiration to improve. The 
House of Correction is more like a workhouse. The short- 
term man should be put to work and made to see that his 
work constitutes a means of his terminating his sentence. 

54 



Indeterminate sentences for all offenders would im- 
prove the situation of the offenders and would put the in- 
stitution upon its mettle to do its work effectively. This 
would necessitate an intensive analysis of each character, 
a sorting out of the men according to learning capacity 
and educational adaptability, both for school training and 
occupation. Our figures show that offenders in Mary- 
land, for the most part, finish their criminal careers be- 
fore they reach middle life. These correctional insti- 
tutions should so manage their work as to shorten this 
period of experimentation and, therefore, shorten the 
work of the correctional institution itself. 

We recognize that the mentally ill should be in hos- 
pitals for the insane. Illness demands hospital treat- 
ment. Persons with social vision universally recognize 
today that the mentally defective delinquent constitutes 
a problem different from that of the delinquent who has 
good intelligence. A defect in personality with good in- 
telligence endowment presents a reasonable problem for 
the correctional institution. The delinquent who is de- 
finitely defective in his intelligence equipment cannot be 
expected to respond to the same stimulations. It is gen- 
erally conceded that he should be treated in an institution 
where his defect is recognized as the fundamental diffi- 
culty in his character and the underlying reason for his 
antisocial conduct. 

The most fundamental need of all for these two institu- 
tions is a thoroughgoing character study of each inmate. 
This study should begin upon admission. We do not 
mean by this a perfunctory examination by psychiatrists, 
much less a rule-of-thumb examination by psychologists. 
We mean a genuine expansion of the work now under- 
taken by the cnaplain and by the Prisoners' Aid Associa- 
tion, by the physician, by the warden, and by the Advis- 
ory Parole Board. This work calls for a man-to-man re- 
lationship between examiner and examinee. It consists 
in getting into the real motives of conduct, just as a psy- 
chiatrist endeavors to understand the perverted motives 
of his patient, who has manifested by his abnormal con- 
duct that his ways of feeling have been diverted from the 
normal channels. Such an examination should ascertain 
what the man really feels when he acts in ways that sub- 
vert the happiness of others and destroy property or lives. 
With such a careful attempt to discover the cause of the 
delinquent's disjointedness with society, with the indeter- 
minate sentence by which he is sent to the institution, 
with proper care of his physical health, proper allotment 



to an occupation, and careful follow-up work as he goes 
through his career in rehabilitation, there should be a 
tremendous salvage of useful human material which as 
a result of present methods often goes out fully deter- 
mined to do the same thing over again, but to do is so 
skillfully as not to be caught. 

Such work involves a very high character in the per- 
sonnel. We recognize that police and penitentiary 
guards ought to be real social workers. It is social serv- 
ice in which they are engaged. What we have said in- 
dicates the high requirements, both in the matter of 
training and natural gifts, for the guards in such insti- 
tutions. These men should be genuine men's men. They 
should be gifted with insight and the ability to serve 
others, for genuine human response can be elicited only 
by such happily endowed persons. The cases with which 
these men deal represent misunderstanding and mis- 
handling in childhood and youth. If these shortcomings 
of their earlier life are to be corrected they must receive 
understanding and skillful handling. 

In the state schools for boys and girls and in the state- 
aided institutions reported herein, there is evidence of 
the same kind of problems as we find among these adults. 
W T e find mentally defective children who should by all 
means be recognized as such and disposed of in institu- 
tions designed for defectives. We find psychopathic 
children and we find minor character defects very much 
as among adult offenders. 

The point of cardinal importance for these peculiar 
children, as for the adults of like endowment, is that they 
be studied, recognized for what they are, seriously treat- 
ed as individual problems in the opportunities for scnool 
work, for play, and for occupation, that are afforded them. 
The same skillful personnel is needed in each of these 
schools as we find necessary in the reformatories for 
adults, and this skill will pay for itself in the obviation 
of many of the adult problems. 

The county jails we have found to afford miserable 
and quite inappropriate shelter for some insane, some 
defective, and many young persons. The jail sentence 
should be abolished. Doing time in a county jail is about 
as subversive of personality and character as anything 
that could be devised. While it continues necessary to 
have such lock-ups for the detention of persons await- 
ing trial, better shelter should be provided them than 
many of these county jails afford. They should be made 
sanitary. 

56 






The large number of mentally defective children found 
in the analysis made in the Juvenile Court of Baltimore 
City calls attention to the high desirability of so organiz- 
ing this court that the thorough mental analysis and so- 
cial analysis suggested above for penitentiary inmates 
should be made also of every boy or girl who comes into 
this court. Such examinations will also reveal many 
correctable defects in these boys and girls which now go 
by unnoticed and which are, therefore, not taken into 
consideration in the diagnosis which should precede the 
prescription — the sentence that the court metes out. 
No doctor is considered a good one who prescribes before 
he examines the patient. No court can be considered to 
be doing its whole duty when it prescribes or metes out 
sentences without knowing the individual offender 
through the analysis afforded by mental medicine. Such 
analysis is fundamental to successful treatment. 

Mental Hygiene and Dependency. 

In the studies reported of dependent children, the men- 
tal-hygiene problems are emphasized similarly to what is 
they are among delinquents. No great preponderance of 
mental defectives is found amongst the dependent chil- 
dren of Maryland, yet such exist. It is important that 
they oe known and treated according to their condition. 
Education of the defective should be so distinctly different 
from that of the normal that this analysis is primarily 
needed to fit the dependent child into his proper training 
school. 

The problems of unusual character make-up are quite 
as frequent in these dependent children as among de- 
linquents. 

It is important not only that every orphanage should 
have the benefit of such mental studies as we recommend 
in correctional institutions, but also that every children's 
aid society should see to it that every child coming under 
its care is given the benefit of a most thorough character 
study as well as a complete physical examination. 

The county almshouse presents serious social problems. 
It does still care for some insane. State care should 
reach out to take charge of all these mentally ill or deter- 
iorated persons. The magnitude of the task is not great. 
The state hospitals should take away from county care 
everyone who is a mental case. 

Of far greater magnitude is the problem of the feeble- 
minded person in these almshouses. It is of greater mag- 

57 



nitude because of its import for the future. The county 
almshouse is not a proper preventorium of the multi- 
plication of these social problems. It abets rather than 
prevents the multiplication of mental defectives. The 
probably 125 feebleminded persons in the 17 county alms- 
houses in Maryland should be immediately provided for 
in state colonies. There is no more productive line in 
which the state of Maryland can invest funds than in 
making proper provision for the care of feebleminded per- 
sons, enabling them to work and produce as much as they 
are capable of producing and at the same time be pre- 
vented from multiplying their kind. 

If the feebleminded and the mentally diseased and de- 
teriorated were removed from the almhouses of Mary- 
land, it would no longer be necessary for the counties to 
maintain these institutions. The poor and aged infirm 
deserve treatment in a real hospital, and some arrange- 
ments should be made to give them such treatment. 

Public School Surveys. 

While details have varied somewhat in different parts 
of our public-school survey work in Maryland, the pro- 
cedure has been the same in essentials. We have made 
a careful mental examination of each individual child re- 
ported upon. 

1. In Baltimore and Carroll Counties, a persona^ in- 
terview was held with every child in school and with the 
teacher concerning each child. We set down in the rec- 
ord the sex, color, nativity, and age of the child, his grade 
in school, the grades he had repeated, his attendance, his 
delinquencies, and the character of his work, the nativi- 
ty and occupation of his parents, the character of the 
home, and the economic status of the family. A mental 
examination was made of every child in the school. A 
mental diagnosis, a statement of his personality make- 
up and his physical abnormalities, were made a part of 
the record. 

2. In Baltimore City, Dr. Cornell arranged with Dr. Tra- 
bue of the Baltimore School Survey to have turned over 
to him the intelligence tests of the children who have 
made the lowest scores. These group tests were the Na- 
tional Intelligence Tests. Three hundred and seventy pa- 
pers, constituting the lowest 9 per cent of 4,137 children 
examined in various grades in various schools all over 
the city, were thus passed over to Dr. Cornell. These 
370 children were given individual mental examinations, 
and interviews with pupils and teachers resulted in ob- 

58 



taming for them all careful records of all the data re- 
ferred to in the paragraph above. 

3. In Frederick, Talbot, and Anne Arundel Counties, 
group intelligence tests were given to all children in all 
the schools visited. These tests were mostly the A. and X. 
forms developed by Dr. Haines from the Army Alpha 
Tests. Some few pupils in the upper grades in Talbot 
County were given the Alpha Tests. Personal history 
records were developed for all these pupils. These gave 
all the data outlined above and in addition thereto noted 
speech defects and provided for a more thorough analysis 
of personality make-up and more details of family and 
medical history. 

On these records were given the results both of the 
group intelligence tests and of the individual mental ex- 
aminations. Individual examinations were given .to 
every child whose group-test score opened him to the sus- 
picion of being a mental defective. Special problems 
brought to our attention by teachers were also examined 
individually. Mental diagnoses were arrived at by indi- 
vidual examination in all problem cases. 

From such surveys of school populations, we secure 
a variety of information not commonly possessed by 
teachers and superintendents. We have made it a part 
of our business to convey to the superintendents and 
principals the results of group-test examinations and of 
individual mental examinations, thus making three im- 
portant contributions to the responsible school authori- 
ties: (1) They are provided with lists of special cases 
who need special schools in order that they may be most 
effectively trained and in order to save the heavy expen- 
diture of money entailed in the present abortive attempt 
to put defectives and dullards over courses of study de- 
signed for normal-minded children. (2) They have put 
before them in concrete form a method by which a men- 
tal-hygiene clinic could continuously aid their schools by 
helping them effectively to adapt educational procedure 
to the needs of individual children. (3) They have in the 
group- test scores and the interpretations of the same a 
fairly concrete grading of the intelligence of each child 
in the school, which enables them to evaluate the prog- 
ress of the individual and the methods of promotion. 

Table XIX presents the distribution of the various 
mental diagnoses by counties, giving the numbers of the 
various kinds of cases. Table XX gives the same data 
distributed by percentages. The studies of the 4,000 

59 



TABLE XIX. DISTRIBUTION BY COUNTIES OF MENTAL 

DIAGNOSES OF 4,839 PUBLIC SCHOOL CHILDREN 

IN MARYLAND. 



Diagnosis 



0) 

P O 



<p 






O 






P 

do 



Superior 439 

Normal 2,684 

Dull normal ___ 733 

Borderline mental defect 178 

Mental defect 165 

Character defect 488 

Psychopathic personal- 
ity 90 

Psychoneuroses and 

neuroses 36 

Mental disease or de- 
terioration 12 

Epilepsy 9 

Endocrine disorder 5 



1 


168 


43 


90 


137 


162 


974 


230 


805 


513 


258 


27 


8 


305 


135 


31 


67 


45 


23 


12 


60 


34 


31 


30 


10 


110 


151 


71 


84 


72 



29 


36 


12 


2 


22 






8 


3 


4 




8 
4 
2 



Total 4,S 



676 1,461 440 1,361 



11 



2 
3 

901 



TABLE XX. PERCENTAGE DISTRIBUTION OF MENTAL 

DIAGNOSES OF 4839 PUBLIC SCHOOL CHILDREN 

IN MARYLAND BY COUNTIES. 





















<L> 














T3 














fi ^ 














53 'O 


<u 




^ 




Diagnosis 




^ c o 








«1 




13 

o 


nne 
Cou 

(Col 


£ o 


2 5 


|8 


13 O 




H 


< 


PQ 


u 


fe 


H 



Superior 9.1 

Normal 55.5 

Dull normal 15.1 

Borderline mental defect 3.7 

Mental defect 3.4 

Character defect 10.1 

Psychopathic personality 1.9 

Psychoneuroses and neu- 
roses 0.7 

Mental disease or deteriora- 
tion 0.2 

Epilepsy - 0.2 

Endocrine disorder 0.1 



0.1 


11.5 


9.8 


6.6 


15.2 


24.0 


66.7 


52.3 


59.1 


56.9 


38.2 


1.8 


1.8 


22.4 


15.0 


4.6 


4.6 


10.2 


1.7 


1.3 


8.9 


2.3 


7.0 


2.2 


1.1 


16.3 


10.3 


16.1 


6.2 


8.0 


4.3 


2.5 


2.7 


0.1 


1.2 



3.3 



0.4 



0.3 



0.6 

0.6 
0.3 
0.1 



Total 



0.7 



0.2 
0.3 



.100.0 100.0 100.0 100.0 100.0 100.0 
60 



children in Baltimore City did not result in data that can 
be presented in the same form, since diagnoses were 
made only in the cases of the lowest 9 per cent. There 
were 3,646 white children and 491 colored given the Na- 
tional Intelligence Test in the City of Baltimore, and 325 
white children and 46 colored were referred for individual 
examination. It must be borne in mind that these chil- 
dren were all in grades above the third, since the National 
Intelligence Tests are not adapted to children in the lower 
grades. These tests were given to the children of not 
more than one or two rooms in a school in various schools 
over the city. The survey is, therefore, not a complete 
survey of any given school, and unfortunately no study 
was made of the younger children in school. 

Of these children studied intensively in Baltimore 
City, 91 white and 3 colored were diagnosed as mental 
defectives. These constitute 2.5 per cent of the total 
number of white children, 0.6 per cent of the colored, and 
2.3 per cent of the total 4,137 children comprised in Dr. 
Trabue's survey. 

Ninety-nine other white children and 20 other colored 
children were diagnosed as of borderline intelligence, 
meaning thereby that it was very doubtful whether or 
not these children were possessed of sufficient intelli- 
gence to be expected to manage for themselves when they 
grow up. The borderline and the mentally defective 
cases together, therefore, constitute 5.2 per cent of the 
white children and 4.7 per cent of the colored children. 

The very smail numbers and percentages of colored 
child J'en diagnosed as of borderline intelligence and fee- 
bleminded emphasize a shortcoming of this work in Bal- 
timore City. In every school for colored children, con- 
siderably larger numbers of defectives have been found 
than in white schools. Compare the results as shown in 
Tables XIX and XX for Anne Arundel County. 

These feebleminded colored children which the Balti- 
more Survey did not locate are in the lower grades. What 
holds so emphatically here of the colored children holds 
in a lesser degree for the white. The majority of feeble- 
minded children found in any white school are in the 
first three grades. The more careful the grading, the 
more certain we are to find the feebleminded in and be- 
low the fourth grade in school. It is safe to assume, 
therefore, that these figures for Baltimore City are too 
conservative. Considerably larger numbers of candidates 
for special schools would be found in any complete can- 
vass by schools. 

61 



General Comparison of County Schools. 

An analysis by schools of the numbers of feebleminded 
children found in the five counties shown in Table XIX 
presents further detail in regard to the spottiness or pock- 
eting of feeblemindedness. In Table XX we see the 
strongest contrast between Talbot County, where only 1 
per cent of 901 children were found defective, and the 
colored of Anne Arundel, where about 9 per cent of 676 
children were found defective. Carroll County stands 
out as presenting 7 per cent of 440 children defective, 
while in Baltimore County and Frederick County we found 
about 2 per cent. 

Table XXI presents similar details by schools, showing 
the total number of children in the school and the num- 
ber and the per cent found to be mentally defective. 
Thus detailed, we find the percentages of mental defec- 
tives to run from zero to 12.5 per cent. Incidentally the 
school that shows 12.5 per cent feebleminded — 5 out of 40 
— also affords three of the nine epileptics found in these 
county surveys. We find in this county of Frederick, 
within a few miles of each other, two schools present- 
ing almost the maximum contrast of the whole survey. 

TABLE XXI. MENTAL DEFECTIVES AMONG SCHOOL 
POPULATION OF PLACES SURVEYED. 

School Mental Defectives 
County Schools Population Number Per Cent. 

Baltimore County Catonsville 511 4 0.8 

Dover Road 33 1 3.0 

Monkton 42 4 9.5 

Phoenix 55 6 10.9 

Sparks 86 3 3.5 

Sparrows Point 569 12 2.1 

Sunnybrook 23 

Towson 142 4 2.8 

Carroll County Mexico 35 

Mount Pleasant 27 3 11.1 

Oregon 28 1 3.6 

Pine Knob 22 2 9.1 

Rovers 34 3 8.8 

Union Mills 41 2 4.9 

Westminster 253 20 7.9 

Frederick County Blue Mountain 40 5 12.5 

Brunswick 805 18 2.2 

North Market 462 4 0.9 

Catoctin Furnace... 54 3 5.6 

Talbot County Easton 605 6 1.0 

St. 'Michaels 170 2 1.2 

Tilghman's Island 126 2 1.6 

Tctal 4,163 105 2.5 

62 



Amongst 462 pupils in the North Market School in Fred- 
erick, there were only 4 defectives located in contrast to 
18 found amongst 800 children in Brunswick and 5 in a 
small school at Blue Mountain. This table affords strik- 
ing evidence, therefore, of the tendency of poor mental 
endowment to run in family strains. Bad stocks, such as 
the Jukes and Kallikaks, are indicated by these high per- 
centages, for closer inquiry often shows that these men- 
tally defective children are closely related. 

In view of this great variation in the incidence of 
mental defect, it is idle to undertake to predict by a 
priori reasoning how many feebleminded will be found in 
any given population. Nevertheless, these facts obtained 
in the field, in various parts of the state, in various kinds 
of communities, and covering, as they do, nearly 5,000 
children, give us not only the actual 165 children found 
in the counties and the 94 in Baltimore City, but also a 
reasonable basis for calculating how many defectives 
there may be in the whole school population of the state. 
Counting in the Baltimore data, which we have shown to 
be ultra-conservative, we find 259 mental defectives among 
8,976 children, or 2.9 per cent. In the report of the State 
Board of Education for the year ending July 21, 1920, the 
total average daily school attendance for the year then 
ending in the schools of Baltimore and of the counties is 
given as 175,000. Two and nine-tenths per cent of 175,000 
gives us in the schools of Maryland today over 5,000 
children who are so handicapped in the way of native 
endowment that there is little reasonable hope for them 
to attain to citizenship and self-direction. 

The aggregate numbers of children of borderline intel- 
ligence, colored and white, in the five counties is larger 
than the aggregate of the feebleminded. These, as already 
stated, are of such low endowment that there is serious 
question in the minds of the surveyors as to the ability 
of these children to profit by ordinary school opportuni- 
ties. Such lame minds as they possess cannot profit by 
a curriculum and a teaching schedule designed for nor- 
mal-minded children. They clog the machinery of the 
school ; they become discouraged ; they prove a vexation 
to the teachers and a hindrance to the regular school 
work. Their presence holds back the normal children. 
To expect them to learn like normal children is to waste 
school funds. 

The dullard (dull normal) is the next higher group. 
This sort of person lacks in imagination ; he cannot use 
imagery as the normal person does, for he has not the 

G3 



mental pictures to use; he does not visualize as other peo- 
ple do. As he reads, words are only words. History and 
literature cannot be interesting to him. But the dullard 
is not a mental defective. He makes a citizen, respectable 
and self-supporting, though in school he often passes for 
a dunce. It is very important that the public school 
should help such an aberrant mind to find itself. The 
school should find a means to develop in him such talents 
as he has, for these often prove to be very useful despite 
the discouragement and blunting that they receive in 
school. His mind necessarily works with the concrete. 
He works with things and with his hands. We found 733, 
or 15.1 per cent, of such children in the five counties. 

The 9.1 per cent — 439 persons — rated as superior also 
need special facilities for their education. Society loses 
incalculable human development by endeavoring to hold 
down its talented children to the pace set by the average 
child. This most gifted class of children is probably more 
valuable to society than all the rest. These children are 
the material for future leadership in art and science and 
social advancement. Their value is greatly curtailed by 
the abuse to which our schools submit them. It would be 
impossible to offer a mathematical statement of the loss 
society sustains by failing to offer proper opportunities 
for development to its gifted children. 

Group Intelligence Tests. 

In school surveys, group intelligence tests have proven 
invaluable. Their most helpful service is in picking out 
the special problems — most particularly problems of intel- 
ligence defect. Such tests enable us to secure an objective 
rating of a child's ability such as it is seldom possible for 
a teacher to give. When we have such results to sup- 
plement the teacher's opinion of the abilities of her pupils, 
we are not likely to miss any of the serious problem chil- 
dren in the school. These tests are also continuously use- 
ful in schools, furnishing a running check upon the meth- 
ods used in promotion, as well as upon the advancement 
of individual pupils. 

For the A. and X. forms of group intelligence tests, we 
have as norms median scores calculated from upwards of 
11,000 children in three different states — Missouri, Mis- 
sissippi, and Maryland. Of the X. form, ordinarily given 
to children in the first three grades, we have 4,900 scores. 
Of the A. form, ordinarily given to children in the fourth 
grade and above, we have over 6,400 scores. These scores 
being arranged in age groups, and in the order of their 

64 



magnitude in these groups, the middle score in each age- 
group series is taken as the normal attainment for a child 
of that number of years of age. In reporting to superin- 
tendents and principals the results of group intelligence 
tests in schools (and this we consider a part of the service 
privileged to a school survey) , we always give in addition 
to the score the mental age corresponding to the score and 
the coefficient of intelligence of each child tested. This 
coefficient of intelligence is simply the quotient obtained 
by dividing into a child's score the expected score for one 
of his age. If a 9-year-old is expected to make a score of 
90 and makes only 72, his coefficient is 80. These reports 
of group intelligence tests are always made with caution. 
They may not adequately report the individual's ability. 
Group tests given under proper conditions will not over- 
rate an individual, but they may not fully present his 
possible performance. 

In order to illustrate another use of the group tests, we 
•nresent a comparison of county groups by means of 
weighted age group coefficients. A weighted age group 
coefficient is the quotient obtained by dividing the total 
number of individuals in a group into the sum of the prod- 
ucts of the numbers in each sub-group by the coefficients 
of the several sub-groups. These coefficients of the sub- 
groups in turn are obtained by dividing the median score 
of the sub-group into the medians above referred to — the 
Tri-state norms. In Frederick County, the 1,278 chil- 
dren thus give a weighted age coefficient of 0.88. In 
Talbot County, 654 children give a weighted age coefficient 
of 1.33. The 459 colored children in Anne Arundel County 
give a weighted age coefficient of 0.48. These totals do 
not tally with the totals of Table XIX for the reason that 
many children not present at the group tests were later 
found and examined by other methods. The closeness of 
the parallel between the percentages of feebleminded chil- 
dren found in Table XX and these weighted age coeffi- 
cients is striking. The lower the coefficient, the larger 
the number and percentage of feebleminded. This con- 
cretely presents a service offered by the group intelligence 
test. A statement of coefficients by schools and by rooms 
compared with Table XXI would bring this more fully 
into view. In the room where a very low coefficient is 
found, there must be considerable numbers of feeble- 
minded. 

The study of individuals, however, affords the real meat 
for such a school survey. The group test leads us by low 
coefficients made by individual children to the selection of 

65 



their cases for individual study — to those who are likely 
to prove feebleminded, of borderline intelligence, or dull- 
ards. No group test is adequate for making a mental 
diagnosis. The group tests do, however, save time and 
also present data of value to school authorities in regard 
to the educational advancement of individuals. 

Psychiatric Examinations and Findings. 

In addition to mental defect, there is another kind ot 
mental abnormality bearing upon school work. We refer 
to aberrations of the emotional and volitional side of life, 
the structure of the character. These variations tend in 
the direction of mental disease as contrasted with mental 
deficiency. Such variations from the normal present 
greater difficulties to the educator than do mental defi- 
ciencies. They are also the abnormalities most in evi- 
dence when we analyze persons before courts, persons 
found in jail, and inmates of correctional institutions. It 
is in this field that education should work to prevent 
crime and other antisocial conduct. The business of the 
school is the socialization of the individual. If the school 
could do its work adequately and properly socialize all 
children, there would be no antisocial conduct. 

No intelligence tests, group or individual, are of much 
use in diagnosing these character aberrations. For mak- 
ing such diagnosis, one must be possessed of the experi- 
ence of the psychiatrist. One must know the abnormalities 
of human behavior from the point of view of the student 
of mental medicine. In Table XIX, we find, in addition to 
the first five lines already referred to, several other dis- 
tributions of mental diagnoses. There are 12 cases of 
mental disease and mental deterioration. These need no 
comment. In popular parlance these are cases of insanity 
or the results of brain disease. There are 9 cases of 
epilepsy and 5 of endocrine disorders. The epileptic always 
deteriorates sooner or later, often manifesting insane epi- 
sodes. The endocrine disorders are most diverse. They 
are apt to manifest nervous symptoms. There are 36 
cases classed as psychoneuroses and neuroses. These are 
still in the field of recognized mental pathology and yet 
they are not classed as insanities, in our old legal phrase- 
ology. They comprise such disorders as hysteria, psychas- 
thenia, and neurasthenia. We then come to 90 cases of 
psychopathic personalities. These used to be designated 
as moral insanities and then at a later day they have been 
called constitutionally inferior persons. The present desig- 
nation seems better to characterize the individual. They 

66 



are not recognized as insane; they have insight and self- 
control when they wish. But they are some of the most 
troublesome persons in our reformatories and prisons as 
well as in the community. Many of them are sex offenders, 
some sex perverts, and many of them drug addicts. 

We find 488 persons diagnosed as having character de- 
fects. This caption serves to designate more or less de- 
cided deviation from normal character development. We 
rind such persons too emotional, hypersensitive, unusually 
lazy and aboulic, too much self-centered, unusually shut- 
in and inaccessible, given to day-dreaming in an abnormal 
degree, or much inclined to magnify, favorably and un- 
favorably, other persons' opinions of themselves, taking 
mere hints to constitute positive statements. These per- 
sons are not psychopathic in the ordinary sense of the 
word; they are variations in the direction of mental ab- 
normality. They may develop into mental abnormalities 
as a result of mishandling. It is an important part of the 
work of any school clinic to point out such potential ab- 
normalities in order that the school may guard against 
inappropriate treatment and may take measures to secure 
normal development. It should be borne in mind, how- 
ever, that these cases would, in many classifications, be 
found among the normals. 

The Feebleminded Child and the Special School 

A serviceable working definition of mental deficiency 
must be social. Such we have had in mind in the diag- 
noses herein presented. It is this that school clinics should 
have in mind in selecting children for special schools. That 
person is feebleminded whose mind (intelligence) and 
character are so backward and undeveloped as child and 
adult that he hinders or interferes with the pursuit of 
happiness on the part of other persons in the community. 
Because of his late and incomplete development, he inter- 
feres with the community development. 

Such persons may be overtly antisocial. They may mur- 
der, steal, spread venereal and other diseases, and be 
otherwise immoral, and they may bring forth abundantly 
of their undesirable kind, for heredity works infallibly in 
these cases. While college graduates have families of t\\ o 
children, these people have families of twelve; and the 
twelve are, every one of them, burdens upon the com- 
munity because of their mental deficiency. 

For all these reasons, it is important for us to protect 
ourselves from the feebleminded. They do not present 
such immediate danger to the individual as does the wild 

67 



maniac who comes out flourishing a knife, yet they are in 
these many ways antisocial and dangerous. 

Seventy years ago, Seguin showed us that mental de- 
fectives were trainable. Our states thereupon began the 
establishment of institutions for training feebleminded 
children. Maryland established Rosewood in 1888. Many 
of these schools have developed colonies where adults are 
kept in custody — a most essential supplement to the train- 
ing school, for some adult feebleminded are more danger- 
ous after training than before. 

A great advancement has come in recent years from the 
intelligence tests originated by Binet. We have made 
great progress in measuring so-called intelligence. No 
psychologist claims to know exactly what intelligence is, 
much less to be able adequately to measure it. It is very 
important for us to keep in mind the impossibility of an 
intelligence test assessing the mind, character, and social 
adaptation of an individual in such a way as to mark off 
by that means alone the feebleminded from the competent. 
No test in itself is adequate for making the practical sepa- 
ration of these social dangers from the rest of the commu- 
nity. An intelligence quotient is an important diagnostic 
aid, but it is only one of many such aids which we have 
at hand. 

We have learned that there are persons of every low 
wits who are nevertheless inoffensive even in the sphere 
of reproductive activity (a biological matter). 

Training helps us to make good, and, therefore, inof- 
fensive and useful, some very poorly endowed children. 
This fact enables us to parole and discharge some persons 
from the State Training School. It also makes it possible 
for the special school in our public-school system to pro- 
vide the necessary training to convert some children who 
constitute social dangers into community assets. It is 
necessary to train or attempt to train and socialize the 
feebleminded as a matter of self-protection. We cannot 
build institutions large enough for all such feebleminded 
children. We could not get them into the institution if 
we did build it; therefore the matter is put squarely up 
to the public school. But entirely aside from these prac- 
tical considerations, it is eminently the business of the 
public school to train all the children of the community. 
The schools are responsible for training for citizenship 
and service. It is their business to offer that training to 
each child which will make him the most serviceable mem- 
ber of society. 



Our present procedure, without special schools for 
these special deficient minds, constitutes a gross misappli- 
cation of tools and material and a waste of the people's 
money. To compel these defectives to attend classes 
wherein they find no appeal to their interests is to compel 
in them the development of undesirable habits. It antago- 
nizes them, it irritates the teachers, and it wastes the 
time of the teachers and of the normal children. It is, 
therefore, not only a waste of money, but a waste of the 
nation's greatest asset — her forthcoming generation. 

The special school must provide more of individual in- 
struction; therefore there must be fewer pupils. Sixteen 
should be the maximum for a teacher. It is also neces- 
sary for the teacher to be especially trained to deal with 
these dull minds. They develop slowly and by means of 
concrete experience, by contact with things, working with 
their hands. Isaac Newton would have been a poor teacher 
of geometry. When he read Euclid, the propositions were 
self-evident to him. He had no use for the demonstra- 
tions. He could not, therefore, see or feel or in any wise 
experience the slow processes of reasoning by which an 
ordinary student masters his geometry. Just so the ordi- 
nary teacher who can teach his kind successfully, having 
only an ordinary normal-school training, would be unable 
to teach the feebleminded. It is necessary for the teach- 
ers of the special school, most of all, to get acquainted 
with the type of mind that such schools deal with to get 
a feeling of the processes by which information and de- 
velopment come to such retarded individuals. 

Because of the special character of the teaching re- 
quired and the small number of pupils desirable for the 
special class, 7 states have provided for state aid to be 
given special schools, paying part of the salary, in most 
cases, of every teacher engaged for a special school. Min- 
nesota, Missouri, New York, New Jersey, Pennsylvania, 
Wisconsin, and Wyoming have such statutory provisions. 
Because the teacher should be especially trained for this 
work, it is generally required that the State Department 
of Education should approve of the establishment of the 
school and of the teacher selected. Some of the states re- 
quire that there shall be special schools established where- 
ever there are ten or more mentally defective children in 
a school district. Some also provide that where there are 
less than ten feebleminded children in a district, contigu- 
ous districts may arrange for the joint establishment of a 
school for mentally defective children. 

69 



A questionnaire sent out by the National Committee for 
Mental Hygiene to 440 cities in the United States — all 
tnose having 25,000 or more inhabitants — and to some 
smaller cities, when mentioned specifically by state super- 
intendents as having special schools, have resulted in 331 
reports, 109 not yet having reported. Of those reporting, 
286 cities report that they have special classes for de- 
fective children and 11 more opened such classes in Sep- 
tember, 1921. 

The same questionnaire has elicited these facts : There 
are in the Union 29 states with urban school populations 
aggregating 7,491,645 in which special classes are to be 
found in some city schools. The enrollment of schools 
in cities reporting special classes is 3,855,772. This is 52 
per cent of the city school population in states having 
some special classes. 

There are 31,384 pupils enrolled in special classes in 
this country. These children constitute 0.81 per cent 
of children enrolled in the schools of the communities 
where such special classes exist. Minnesota has 1.4 per 
cent of her urban school population in special classes. 

The city of Baltimore has 30 ungraded and special 
classes ; only three of these, with 56 pupils, are for mental 
defectives. This is far below the necessary provision for 
the mental defectives in Baltimore. The classes vary 
widely in equipment, teaching, and organization. Facili- 
ties for examining children — not only to note their prog- 
ress in such work, but to determine what children shall 
go into the work — are very inadequate. The supervision 
of this work, as well as the clinical equipment, is quite in- 
adequate. In the counties there are no special schools. 

This situation constitutes an imperative demand upon 
the public schools of Maryland to provide special training 
facilities for Maryland's defective children. 

The plan of state aid for this special kind of education 
seems to be the rational means of providing it, and it being 
such special work, it seems highly important that its or- 
ganization and supervision should be quite directly under 
the state superintendent of education. 

Dullards. 

The dullard mind is atypical in imagination. This men- 
tal handicap does not make its possessor a social burden. 
It is, therefore, our first duty as educators to try to make 
of these dullards the most useful citizens possible — useful 
to themselves and to others. They cannot progress in 

70 



regular classes because of the atypical imagination, the 
lack of imagery, in their endowment. They balk at some- 
thing — it may be arithmetic, it may be spelling. For 
thece, special classes, cr rather individual instruction, are 
indicated. It would not be right to put them into classes 
with the mentally defective. That would be the worst pos- 
sible disposition of such cases. It would drive them from 
the school. The country school, which allows every one 
to go at his own pace, is the ideal school for such children. 
The so-called ungraded class in our city or consolidated 
schools is best adapted to the dullard. With each special 
child, it is necessary to study his aptitudes and interests. 
The mental clinic will often find the dullard's special 
myopia, and point the way to its correction. Mental and 
other medical studies of these children will richly repay 
the cost in the aid furnished to the teachers and in the 
happiness brought to the children. This class of children 
then, point to two special needs: (1) the mental clinic, 
(2) the opportunity for individual instruction. 

The Nervous or Psychopathic Child. 

We find in these studies 152 children, or 3.1 per cent, 
among the 4,839 of the five counties comprised in Table 
XIX, who are epileptics, endocrine cases, afflicted with 
mental disorders, psychoneurotics or neurotics, or psycho- 
pathic personalities. These are nervous and mental cases. 
They present by no means such unpromising material for 
salvage as the mentally defective. In these children, we 
often find some of our best talent. On the other hand, if 
neglected, they are the most sure to become delinquents 
and to give society trouble. 

Besides these, there are 10 per cent whom we desig- 
nate as having character defects. These are verging in 
the direction of nervous or mental disorder. They are un- 
duly emotional, egocentric, secluded, or handicapped with 
some other abnormality of the will or emotions ; but such 
abnormality does not eventuate in serious aberrations of 
conduct from ordinary social standards. 

Among these 4,839 children of the five counties and 
those in Baltimore City, we find 213 children afflicted with 
speech disorders of one sort or another. In Anne Arundel 
County, 18 of these were found amongst 676 children, con- 
stituting 2.7 per cent. In Baltimore City, 25 were noted 
among the 301 cases especially studied. In Baltimore 
County, 41 cases of speech defect, or 2.8 per cent, were 
found amongst the 1,461 children. In Carroll County, 16 
children, or 3.6 per cent of 440, were found; in Frederick 

71 



County, 76 cases, or 5.6 per cent of 1,361; and in Talbot 
County, 34 cases, or 3.8 per cent of 901 children ex- 
amined. 

There is much variation shown in the distribution of 
speech defects by county groups, ranging from 2.7 per 
cent to 5.6 per cent. It also varies much from school to 
school. In Frederick County, for instance, Brunswick 
School, with 805 children, reported 41 cases, or 5.1 per 
cent. In Catoctin Furnace, no cases were found. At Blue 
Mountain, three cases amongst 40 children constituted 
7.5 per cent, and at North Market School in Frederick 
City, 32 cases of speech defect amongst 462 children con- 
stituted 6.9 per cent. 

Speech defects, such as letter substitution, oral inactivi- 
ties, and stuttering and stammering, as classified by Dr. 
Smiley Blanton, are in many instances essentially neurotic 
or psychopathic conditions — that is, the child has the 
speech defect because of a nervous condition, and success- 
ful treatment is directed to the nervous disorder. The 
noting of these defects, therefore, constitutes another in- 
dex of the predominance of nervous or psychopathic chil- 
dren in these schools. As such, it constitutes further evi- 
dence of the need of special clinical facilities in the schools 
and special educational facilities for dealing with this spe- 
cial sort of child. 

Mentally Defective Colored Children. 

A casual glance at numbers and percentages of the 
mentally defective, borderline mentally defective, psycho- 
pathic personalities, and psychoneurotics, in Tables XIX 
and XX, for Anne Arundel County, which is a study of 
colored children exclusively, indicates the mental prob- 
lems involved in the education of these colored children. 

One-third of these children were studied in five rural 
schools, the remaining two-thirds in Stanton School, An- 
napolis. There is no significant difference between the 
incidence of these problems in the country schools and in 
the Annapolis school. They present here, however, marked 
differences from their incidence in white schools. There 
are fewer children whom we can designate as of normal 
mental constitution, only one of superior intelligence, and 
considerably larger numbers and percentages of mentally 
defective in intelligence and with outstanding character 
defects. 

Tne indications are, therefore, that there is more need 
for special classes amongst the colored than amongst 

72 



the white. This is to be expected. These children need 
to have considerable emphasis placed upon the cultivation 
of manual detxerity. They all need training through the 
use of the hands. Their minds can be developed best with 
concrete material. By this means they can be aided in 
getting possession of imagery by which they can leam 
10 think and act according to the facts presented by their 
environments. The development of citizenship which will 
come with this developed capacity to think and act ration- 
ally will amply repay the institution of careful medical and 
mental studies of these children and the organization of 
the educational work to fill the prescription of the physi- 
cians. 

Mental Hygiene in Education. 

The analysis of mind and character of the school child 
in five counties of Maryland demonstrates the existence 
of mental-hygiene problems in the schools. These prob- 
lems are shown to be of such a nature tnat, if their ex- 
istence is not known, education cannot be effective. There 
are conditions for the proper growth of mind, just as for 
any other growing organism. These conditions must be 
favorable or growth is stunted. We must know the mind 
that is to be trained before we can train it properly. 

The single curriculum and the single school schedule 
fail to fit both the highest and the lowest in development. 
We are w T ell aware that special provision must be made 
for the superior as well as the dull. The highly endowed 
child will progress through the eight grades sometimes in 
four years and develop thereby better than the average 
child in twdce the time. The dull child, with his lame 
imaginative faculties, is incapable of doing some of the 
school w T ork, while in other lines he can progress normally. 
For minds of this sort the ungraded class is indicated. 

The mentally defective need special schools both for 
their own sakes and for the sake of others. They hinder 
the normal child out of all proportion to what they gain 
themselves, and the gain to themselves is quite incom- 
mensurate with the effort expended upon them when they 
are carried along in regular classes. These children are 
so markedly lame in endowment that they require indi- 
vidual instruction and that instruction directed to the 
training of the hands in concrete manual activities. It is 
through the co-ordination of muscular movement that 
mental processes co-ordinate and develop. These children 
require special instruction, the progress of which is care- 
fully adjusted to the development of each. 



The endocrine, epileptic and mental disorder cases are 
definitely recognized as medical problems. These matters 
are as readily recognized as belonging to the doctor as are 
troubles of the eye, ear, nose, and throat, but, in addition 
to being matters for the physician's attention, they must 
be referred to specialists in nervous and mental disorders 
in order to secure the analysis and prescription required 
for the best education of the child. 

The psychopathic personality is a further step in the 
direction of normality, but is still in the clearly recognized 
field of mental medicine. The minor character defects of 
which we note so many hundreds are abnormalities in 
personality structure and character formation which can 
be understood only by the student of the abnormalities of 
human behavior. In fact, all these abnormalities must 
come under the observation of one versed in mental medi- 
cine, one who knows the anomalies of character develop- 
ment, the perversions and twistings of instinctive and 
emotional tendencies, the snags upon which the develop- 
ing person strikes during his course, and the means of 
correcting the perversions when observed. This is what 
we mean by analysis of character and prescription of edu- 
cational correctives. It is obvious that this sort of clinical 
work is not concerned with any special part of the school 
population. All children must come under the observa- 
tion of such a mental analyst. 

The outstanding needs indicated by these county sur- 
veys are: 

1. The development, in the office of the superintendent 
of education, of a clinic for child study. This must be a 
traveling clinic, able to go to any school anywhere in the 
state and study the children. This work will be devoted 
to the study of the child and his development, rather than 
to the efficiency of the school as such. Its concern will be 
with intelligence tests and measurements and with indi- 
vidual studies of personality and relation to home and 
school life. In addition to analysis, its work will consist 
in prescribing for the children found to be anomalous, 
whether in that part of mental development which we con- 
sider intelligence, or in any other aspect of personality 
development. 

2. For the majority of these special problems, it is 
probable that the special school will constitute the body 
of the prescription. We refer to the special school that 
has not more than 16 pupils to a room and teacher, so that 
individual instruction can be given, a room where hand- 
work will be emphasized, work with the concrete, tangible 



things in the child's environment calculated to organize 
his mind through the action of his muscles. For the suc- 
cess of this work, a specially trained teacher is required. 
3. In order to carry out this plan for special schools 
and the necessary clinical work, it would seem well for 
Maryland to consider the plan of state aid which has been 
found successful in other states. An appropriation put at 
the disposition of the state department of education, for 
paying half the salary of each such special teacher en- 
gaged, would at once give the necessary encouragement to 
local authorities to organize such schools and would give 
the state superintendent the necessary direct supervision 
over such special schools. 

In the city of Baltimore, where we found 94 definitely 
mentally defective children and 119 others diagnosed as 
borderline mentally defective among 371 children ex- 
amined, there is striking evidence of the need of further 
organization in special-school activities. In Baltimore, 
there are 30 special and ungraded classes. These are very 
mixed in their organization. Some are in very poor quar- 
ters. As a group, they are poorly supervised. For some 
of the schools, the teachers test the children; for other 
schools, they are sorted out without any test whatever. 

It is important that a department of child study be or- 
ganized in the office of the superintendent of schools — 
that it be put in charge of the whole question of studying 
problem children and of prescribing the modifications in 
instructional procedure suitable to the child's condition. 
This would include assigning the children to special 
schools. This department would best be put in charge of 
organizing special schools to the extent necessary to take 
care of the education of these special cases. What has 
been said concerning the nature of these special cases 
indicates the kind of talent that such child-study bureau 
or clinic would have to have in order to do the work suc- 
cessfully. It is a broad study of developing human nature 
that is called for. 

In dealing with these problems children both in Balti- 
more and in the counties, there will constantly arise cases 
unsuitable for remaining in the school and in the home. 
For such cases, Rosewood State Training School has been 
designed. It is manifestly unable to supply the places de- 
manded. In order to fulfill properly its function in Mary- 
land, this training school must needs be considerably en- 
larged. 

In order to control the mentally defective not gifted 
with adequate powers of self-control themselves, it is 

75 



highly important to organize through legislation a plan 
by which the superintendent of schools will report to some 
proper state authority the names of all feebleminded per- 
sons at the time of their leaving school, and other facts 
concerning them. 

Care of Mental Defectives in Maryland. 

Dr. Richard Gundry, then Superintendent of Spring 
Grove State Hospital, was personally interested in the 
establishment of the Rosewood State Training School in 
1888. Dr. Gundry was impressed with the needs of feeble- 
minded children committed to the state hospital. He had 
also very freshly in his mind the work of his colleague 
in Ohio, Dr. Doren, then Superintendent of the Ohio Insti- 
tution for the Feebleminded. The Maryland Asylum and 
Training School for feebleminded, now the Rosewood 
State Training School, was incorporated in 1888. 

It has grown to a capacity of 700. It is located on 581 
acres of good land about 14 miles north of Baltimore at 
O wings Mills. The buildings are happily located on high 
ground in a quadrangle which will be completed by the 
hospital building for which provision has already been 
made. The central administration building is also a serv- 
ice building and a laundry. It provides a dormitory for 
some older girls. On either side in the rear are school 
buildings for boys and girls, and cottages in line with 
these reach down to the projected hospital. 

This is a home for white mentally defective children 
admitted from the ages of 7 to 17 years. It is definitely 
a school, rather than a custodial home, though there are 
many low-grade cases incapable of training. The chil- 
dren are classified by mental development as far as build- 
ings permit. Most of the work of the institution is done 
by the boys and the girls. The educational work is or- 
ganized along industrial lines. There is due recognition 
of the place of play in the development of the child. 
There is no provision for, or activity in, lines of research. 
The board paroles children. About 80 are reported to 
have been paroled and released during the last year. A 
too frequent practice of resorting to habeas corpus pro- 
ceeding^ and a too frequent concurrence by the court in 
removing children from the custody of the institution is 
subversive of the social service this institution is capa- 
ble of rendering. Maryland stands in need of a commit- 
ment law for mental defectives that will make state 
wards of persons incapable of managing themselves in 
conformity with the best happiness of others. 

76 



A study of the relationships of inmates shows how work 
is provided not only for this training school, but also for 
children's homes, for county almshouses, for reforma- 
tories and penitentiaries. Miss Griffith, in August 
1917, found 144 feebleminded inmates of the Rosewood 
State Training School who belonged to 54 fraternities 
(groups of brothers and sisters). They included 16 
groups of three and 48 groups of two. Six of these 
groups have cousins or other relatives in the institution. 
Three children of one family are first cousins of three 
in another family, all six being then in the institution. 
Several of these groups were transferred from various 
other institutions for dependent children, and no facts 
are obtainable about their origins. In the majority of 
cases, however, there are some records of the parents 
of each group. Of the 64 fraternities, it is known 
that 14 of the fathers were feebleminded and 31 of 
the mothers. Six other fathers and 6 other mothers 
were reported of low mentality. Three of these par- 
ents had been admitted to institutions for defectives. 
Seven mothers and 4 fathers were insane; 5 fathers and 
one mother had criminal records; 34 fathers and 10 
mothers were alcoholic; 2 fathers and 15 mothers were 
sexually immoral; and 2 fathers and 3 mothers were 
syphilitic. 

The paramount need of Maryland today, in meeting 
the mental-hygiene problems already discussed, is that 
of more land and buildings for the Rosewood State 
Training School. The scope of the work of this insti- 
tution needs to be broadened so that it will be able to 
care for more children. There is a pressing need from 
the public schools, from children's aid societies and child- 
caring agencies generally, a need far beyond the 300 on 
the waiting list of the superintendent. Preparations 
should be made to meet this pressing demand. From the 
analysis we have made of populations of delinquents, it 
is evident that there are feebleminded adults who should 
be cared for in institutions, and there are delinquents, 
minor and adult, who are as inappropriately cared for in 
our correctional institutions as are feebleminded chil- 
dren in our regular schools. 

It is important, also, that mentally defective colored 
children and adults, delinquents and non-delinquents, 
should be cared for both as to training and as to custody. 

The immediate need calls for the purchase of at least 
1,000 acres of good land for the establishment of colonies 
for males, with special buildings for delinquents who are 



defective. There is no reason why these outlying col- 
onies should not be under the direction of the superin- 
tendent of the present Rosewood State Training School. 
In fact, reasons of economy dictate such a plan. On this 
account it is important that the land for the colonies 
should be located as close to the present tract at Rose- 
wood as will secure good agricultural land at values based 
upon productivity and not upon proximity to Baltimore. 

Epileptics in Maryland. 

The lot of the non-insane and non-deteriorated epi- 
leptic, whether child or adult, is a hard one, but it seems 
particularly hard in the case of the growing child. Of- 
tentimes he is excluded from school simply because his 
attacks are an offense to other children and an interrup- 
tion of school activity. With the present arrangements 
in Maryland, there is no proper place for the training of 
such a child. Such persons are often sent to the Rose- 
wood State Training School or to a state hospital. A 
case has already been mentioned where a boy was recom- 
mended to an insane hospital, but was sent to St. Mary's 
Industrial School. 

Another case is that of Herman . He was born in 

1905. It was an instrumental delivery. -He had infantile 
paralysis at nine months, which left paralysis of the left 
side. He is subject to epileptic attacks dating from this 
illness. He started school at 7, spending a year and 
a half in the first grade, three years in the second, and 
then one year each in the third, fourth and fifth. He 
was a truant and did poor work. At 14 he applied 
for a work certificate. Employment was difficult on ac- 
count of his attacks. Rosewood and the Maryland 
School for Boys were discussed with the mother. He was 
committed to Rosewood. After a month he ran away 
and returned home. He said he would not stay there 
because "there were crazy people there." Soon he was 
in the Juvenile Court on a charge of disorderly conduct. 

While there is no certainty that any treatment would 
serve, in such a case, to diminish the severity or fre- 
quency of attacks, it is certain that the boy needs insti- 
tutional care and that it is most humane as well as most 
scientific to put him in an institution where he can have 
the best that medical science can give him. It is not 
wise to place such individuals with the feebleminded or 
with the insane or in a correctional institution. As long 
as he has attacks, he should be submitted to such thera- 

78 



peutics as medicine can devise. The regimen of his daily 
life should be regulated with a view to diminishing his at- 
tacks and increasing his usefulness. 

Dr. J. Clement Clark, Superintendent of the Spring- 
field State Hospital, in his report of October 1, 1919, es- 
timated that there were in Maryland 340 insane epi- 
leptics. He stated that there were at Springfield State 
Hospital 139 insane epileptics. Dr. Clark was advocat- 
ing and still advocates a group of cottages at Springfield 
State Hospital for epileptic insane persons. He does 
this from motives of humanity and economy. It would 
undoubtedly be to the benefit both of the epileptics and 
of the other patients at Springfield to effect such a sep- 
aration. The non-epileptic would be spared the specta- 
cle of attacks and the epileptic would be given the benefit 
of one-story cottages where falling would be less dan- 
gerous and of a diet arranged especially with a view to 
diminishing their attacks. On the other hand, if separ- 
ate kitchens were instituted for this epileptic group, it 
would break into the present economical arrangement of 
three kitchens for the whole institution. It would also 
break up one of the most admirable features of the 
Springfield State Hospital, namely, the isolation on sep- 
arate hilltops, more than half a mile apart, of the men's 
and women's groups. This is one of the most potent con- 
tributors to the open-door character of the female wards 
of this institution, and one cannot lightly make plans 
to thwart such a happy feature of the hospital. 

But the insane epileptic apart, Maryland does need a 
hospital for epileptics, and given such a hospital, the 340 
insane epileptics might be taken in charge by its medi- 
cal superintendent. This would at once provide consider- 
ably more space in present state hospitals for the insane 
who are at Sylvan Retreat, Bay View, and in county alms- 
houses. 



79 



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80 



Summary. 

By the collected percentages of the various mental de- 
fects and disorders in the several groups and institutions 
surveyed which we have presented in Table XXII, we get 
a bird's-eye view of our findings. The total populations 
in the various groups are given and the aggregate popu- 
lations surveyed are 11,499. 

The clearly defined mental defectives are found in 
largest percentages in county almshouses with 24.2 per 
cent; government venereal clinic, 18.5 per cent; Balti- 
more Juvenile Court, 17.7; Penitentiary and House of 
Correction, 11.8 per cent; colored schools, 8.9 per cent; 
four juvenile institutions, 8.5 per cent. 

The heaviest additional complement — the borderline 
mental defectives — is found in the Baltimore Juvenile 
Court, with 17.7 per cent. Then follow Penitentiary and 
House of Correction, 10.9 per cent; government clinic, 9.8 
per cent; county jails, 9.3 per cent; and four industrial 
schools, 5.3 per cent. 

Only the white public schools and the government 
clinic present 50 per cent or more normal mental condi- 
tions. Heavy complements of dullards are observed 
throughout. 

The county almshouses present the heaviest comple- 
ment of mental disease and deterioration. Half of the 
inmates are such. County jails are next, with 5.4 per 
cent. Two of these cases, we recall, were waiting in jail 
for transportation to a hospital. 

The psychoneuroses and neuroses run 7.5 per cent in 
four industrial schools, 5.3 per cent in the Penitentiary 
and House of Correction, 3.3 per cent in the government 
clinic, and 3.3 per cent in the colored schools. 

Psychopathic persons run heaviest in jails with 21.3 
per cent. Then come Penitentiary and House of Correc- 
tion with 16.9 per cent; the four industrial schools with 
10.6 per cent; Juvenile Court, 4.9 per cent; and the gov- 
ernment clinic, 4.3 per cent. 

Minor character defects are found in considerable num- 
bers in the four industrial schools and amongst the col- 
ored school children. 



81 



Conclusions. 

1. Mental Defectives. 

This presentation of the needs of Maryland in the 
matter of the care of mental defectives is striking. They 
are scattered everywhere. In every group of depen- 
dents and delinquents we find them in large numbers. 
Wherever there are social problems, there are mental 
defectives. They are also in the public schools. It is 
incumbent upon us to train these mentally defective chil- 
dren and to watch over them as children for the protection 
of the community. 

2. Special Schools. 

The importance of the organization of schools especial- 
ly adapted to deal with the slowly developing mind of 
the mentally defective child cannot need further insis- 
tence. They do not profit by regular school work ; rather 
they are driven from the school because they are expected 
to be interested in things that cannot draw out their men- 
tal powers. 

3. Child Study Clinics. 

In order to organize these special schools for mental 
defectives, it is essential to have traveling clinical facili- 
ties which can go to the school and designate children 
who should have individual opportunities in manual train- 
ing and the simple arts of life, because of their congenital 
mental defects. Such a clinic, once organized, will inevi- 
tably point out psychopathic persons and psychoneurotic 
and nervous children, and indicate the kind of special 
care which these need. In this way such clinics will 
make salvage of valuable material for citizenship by 
bringing to many talented, but ill-understood children 
the opportunities that nature designed for them. Such 
clinics both in Baltimore City and in the counties should 
assume vocational probation work for backward children. 

4. Reporting Defectives. 

After the schools have expended the energies of ex- 
aminers and teachers upon these mental defectives for 
years, it is important that the community should not 
loosen its control over them. Really mentally defective 
persons remain children as long as they live. Unless 
home conditions are very exceptional, it is important that 
some agency should continue to have oversight and con- 

82 



trol of them. The school authorities should be required 
regularly to report all mental defectives, upon leaving 
school, to some central state agency. 

5. State Training of Defectives. 

Many children have been found in Maryland, in insti- 
tutions for correction, who are definitely mentally de- 
fective. They are unsuitable cases for the public schools, 
else they would not be taken in these institutions. They 
are unsuitable for these institutions because they are 
mentally defective. State training facilities, such as 
those at Rosewood, should be expanded so that all such 
children who are feebleminded and who are unsuitable for 
retaining in the public schools should be cared for and 
trained. 

It is likewise important that state facilities should be 
developed for the custody of the feebleminded adults who 
cannot be managed under surveillance in the community. 
Feebleminded delinquents should be recognized as rela- 
tively unreformable and provision should be made for 
them in colonies in which they can remain for life. Put- 
ting such in the care of an institution is in no sense a life 
sentence, any more than it is a life sentence to be sent to 
a hospital for the insane. It is a recognition of the men- 
tal condition of such individuals and a prescription of the 
treatment indicated for them. 

It is important that provision be made for the train- 
ing and the custody of feebleminded colored children and 
adults. Separate colonies or separate buildings can read- 
ily be established under the Board or Commission and the 
superintendent of the present institution at Rosewood. 

At least 1,000 acres of land should be purchased at an 
early date. It should be good agricultural land. It 
should be near enough to the Rosewood State Training 
School to make it easily manageable by the superinten- 
dent of that institution, and it should be far enough from 
cities to be purchased for what it is worth for farming 
purposes. Buildings on this purchase should be used 
for colonies of adult males. A colony for adult females 
might perhaps better be established on the present tract 
at Rosewood. The findings of this survey clearly indi- 
cate the importance of greatly expanding the training fa- 
cilities at Rosewood and the establishment of generous 
accommodations for the custody of adult males and fe- 
males and for delinquents and for colored. 

83 



6. Community Care of Mentally Defective Persons. 

Large numbers of persons who are clearly mentally de- 
fective can be maintained safely in the community, but 
they need surveillance. Oftentimes such a person is 
managed satisfactorily while his parents live and main- 
tain a home for him, but upon the breaking up of the 
home, he runs amuck. If such a person were on the lists 
of the Mental Hygiene Commission and in the care of a 
psychiatric social worker, this waste would be prevented. 
Probably definite commitment to the care of the Mental 
Hygiene Commission would be the best preventive. 
Such patients could be carried under the care of the 
Commission in exactly the same manner as patients who 
have been in an institution, but have been paroled. For 
many defectives, institutionalization is not necessary, but 
surveillance is most important. 

Anyone who remains unable to handle himself with 
such prudence and self-control as make him a comfortable 
resident in the community should be under such surveil- 
lance. This means that the termination of care on the 
part of the Commission will rarely occur short of the 
death of the individual. Whether in an institution or 
cared for in the community, his parole in most cases will 
be for life. Such a conception of community manage- 
ment of the feebleminded involves a large staff of field 
officers. 

The central authority might be the superintendent of 
the training school and colony for the feebleminded. With 
the enlarged field of work above indicated for this sup- 
erintendent, it would seem best that the commitment of 
the feebleminded whom it is designed to maintain in com 
munity care should be made to the Board or Commission 
of Mental Hygiene. An additional reason for this is 
that the time may come when Maryland may have more 
than one institution for the care of the feebleminded. 
Still further, the care of paroled patients from the in- 
sane hospitals will naturally be under this Commission. 
Therefore, their care of mentally defective as well as of 
mentally diseased persons in the community will secure 
economy and efficiency in administration. 

7. State Care of the Insane. 

When the non-insane mentally defective persons are 
removed from the four state hospitals, as is contemplat- 
ed in the plan for the care of the feebleminded outlined 
above, these hospitals will be able to take over all the 

84 



insane now confined in the Sylvan Retreat, the Insane De- 
partment at Bay View, and the county almshouse. This 
is an achievement that has been promised long to the 
people of Maryland. The accomplishment will clear up 
the record of the state and place Maryland in the list of 
the most advanced states in the care of her mentally dis- 
eased persons. 

8. Psychopathic Hospital at Spring Grove. 

The completion of the Foster Clinic and putting it at 
the service of the people of Maryland, especially those of 
the city of Baltimore, with an ambulance service from 
all parts of the city, will constitute the final step in doing 
away with the necessity of caring for any insane person 
in an almshouse or jail in the City of Baltimore. Steps 
should be taken at the same time to secure the easy com- 
mitment of mentally diseased persons. It should be no 
more difficult for one who is mentally ill to be hospital- 
ized than for one who is seized with typhoid fever or who 
breaks his leg. 

9. Nursing and Occupational Therapy in State Hospitals. 

It is important that the nursing facilities and the fac- 
ilities for training patients through occupation and re- 
creation should be improved in all these hospitals. 
Nurses' training schools should be fostered. Perhaps the 
two in operation are sufficient to produce a supply of well- 
trained nurses and attendants, if they are made properly 
attractive. 

10. Organization of Clinics. 

One of the greatest community services of the hospital 
for mental diseases is that of the visiting clinic. A psy- 
chiatrically trained social worker and a physician, at a 
given center at a given time, make a most satisfactory 
arrangement for inspecting paroled patients who can 
come in for examination and report. Such a clinic also 
affords the opportunity for any person in the community 
to make inquiry about suspected mental or nervous dis- 
order of any kind for himself or for others. The same is 
true of mental defectives. Parents and teachers and 
social workers can make use of such clinics for the ex- 
amination and diagnosis of problem children. 

11. Psychiatric Social Workers. 

The psychiatrically trained social worker is already 
proving a most valuable ally of the physician in the pre- 
vention of mental disorder. Such field workers should 

85 



be employed by the Commission of Mental Hygiene or 
other properly organized authority in considerable num- 
bers in the state of Maryland. The experiment has been 
tried and it is known that they can save their salaries 
many times over in the salvage they effect and the pre- 
vention of mental disorders they are able to bring about. 

12. Epileptics. 

The establishment of a hospital for epileptics is an im- 
portant addition to the institutions already laid out in the 
state of Maryland. It should be able to take children 
as' well as adults, sane as well as insane, colored as well 
as white. This indicates, of course, the cottage plan of 
institution, in order that separations can be effected ac- 
cording to age, sex and mental condition. The or- 
ganization of such a hospital would further relieve the 
state hospitals for the insane. 

13. Juvenile Court of Baltimore. 

This court needs reorganization. The children's 
court should be made a branch of the Supreme Court of 
the City of Baltimore. It should be given complete jur- 
isdiction in children's cases. It seems advisable that it 
should be organized on a broader basis as a court of do- 
mestic relations and take over jurisdiction in all matters 
of family relationships. This is the only way in which 
complete and ultimate treatment can be given to the 
problems of childhood that come to court. * 

The court should have facilities whereby complete 
psychiatric examination can be made and diagnosis and 
suggested treatment from the clinician be received by 
the court before sentence is pronounced. The court's 
procedure and efficiency would be greatly improved by 
means of a proper organization of the probation force 
and the institution of a good system of records. 

It would be advisable for the court, when committing 
to such institutions as the industrial training schools 
comprised in this survey, to give the child over to the 
management of the institution until he attains his ma- 
jority, as the law provides, and to leave it to the institu- 
tion to work out with the child the time of his parole and 
the time of his discharge. 

14. Other Courts. 

Clinical examinations of accused persons should be pos- 
sible wherever there is any reason to question the men- 
tal condition of the accused. 

86 



The indeterminate sentence has commended itself gen- 
erally as being in line with the most rational adminis- 
tration of what we know as to the best methods of re- 
formation and rehabilitation of character. It is impos- 
sible for the judge to know at the time of pronouncing 
sentence what is going to take place in the development 
of the character before him. No man can know, and 
society is not seeking to work retribution upon the of- 
fender. The object is to rehabilitate his character and 
restore him to productive citizenship. 

15. Juvenile Reformatory Institutions. 

The importance of clinical facilities for the analysis 
of character and the determination of motives and en- 
vironmental situations that have led the juvenile offen- 
der to become such are generally appreciated. It is im- 
portant that the management of every such institution 
should provide itself with such facilities that they may 
know about the individual child when he begins his resi- 
dence, and that they should watch his progress by the help 
of such clinical examination from time to time. It is 
likewise important that children's aid societies and chil- 
dren's homes should provide themselves with similar 
facilities for all their problem children. Most of their 
children are problems. 

16. Penitentiary and House of. Correction. 

These institutions should have clinical facilities where- 
in characters would be studied. This clinic in such an 
institution is confronted wth more difficult problems. 
These institutions get the old and knotty problems. 
Many cases are "hard-boiled" or "case-hardened." They 
are quite inaccessible to the ordinary means of analysis. 
Their inaccessibility constitutes their abnormality in 
large measure. Getting next to these older offenders is 
a real man's job, and no one man can do it. The clinic, 
in one of these institutions, should be the center around 
which the activities of the whole staff should revolve, 
fcuch a conception of the work of the institution involves 
a kind of guard not usually found in the penitentiary. 
From the point of view of institution management, of 
course, discipline is the first object, and discipline is 
needed by the individual. It is important in his refor- 
mation. When, however, we can get in such an institu- 
tion a staff every member of which conceives it to be 
his first business to help the man under his charge to 

87 



find himself as a man and a member of the social group, 
then we shall have a penitentiary that is a real reforma- 
tory. 

17. Occupation in the Penitentiary and House of Correc- 

tion. 

Self-support is an important attainment in such in- 
stitutions for adult offenders. There is no reason why 
the men and women should not support themselves dur- 
ing the time the state is rehabilitating their characters. 
But the first consideration should always be this mak- 
ing over of the man, and occupation for the man, em- 
ployment for his energies, is one of the best considera- 
tions to be looked after. Employment is absolutely nec- 
essary for the continuance of good mental health in 
anyone, and it is through work that we secure character 
and socialization. It is important that the work pro- 
vided for an offender should be work that he can pursue 
when he is discharged. Life in the reformatory or pris- 
on is a preparation for his life in the community. There 
should be no break, binding himself means finding him- 
self as a working, contributing member of society; there- 
fore his work in prison should be work that he enjoys 
and that he can pursue through life. 

18. Administration of Mental Hygiene. 

The state of Maryland has been particularly fortunate 
in the quality of citizenship whose service she has had 
on the Lunacy Commission these 30 years past. The 
present care of the insane is largely a monument to the 
unselfish service of these gentlemen. They are an ad- 
visory board in the management of the four hospitals 
for the insane and the Rosewood State Training School, 
and they have supervisory powers over private and coun- 
ty institutions caring for the insane and feebleminded. 

The magnitude of the mental-hygiene problems in Mary- 
land today indicates the advisability of enlarging the func- 
tion of this Commission. Lunacy is a term of opprobrium. 
Mental hygiene better characterizes the enlarged field we 
have in view. The executive of this Mental Hygiene Com- 
mission, whom we might call commissioner, should be a 
full-time executive, well-trained in psychiatry. The other 
members of the Commission would constitute an advisory 
council. The real authority should exist in the Commis- 
sion, but the chairman of the council, or the commis- 



sioner, should be the active man always on the job and 
doing the real work. 

This Commission might well have charge of the hos- 
pitals for the insane and the Rosewood State Training 
School, in a much more intimate way than they have at 
present. It would secure uniformity of high quality serv- 
ice in all institutions throughout the state to give the 
power of appointing the superintendents of these institu- 
tions to the Commission on Mental Hygiene, such appoint- 
ment to be approved bv the local boards of managers. 
Power to discharge such superintendents should likewise 
inhere in the Commission, properly guarded to prevent 
discharge for anything other than failure to perform 
satisfactorily the functions of their office. 

The primary reason for suggesting: this enlarged exec- 
utive power of the Mental Hygiene Commission is for the 
organization of clinics for service in the community, in 
courts, and, if asked for, in schools. The next and equal- 
ly important ground for such recommendation of enlarged 
power is the securing of adeauate care of the feeble- 
minded. There are many feebleminded persons who do 
not need commitment to an institution. They can be 
cared for in the community in the same manner as the 
feebleminded and the insane who have been in institu- 
tions and have been paroled. This community care can 
best be secured by committing the individual to some 
central authority. Such authority we conceive to be a 
Mental Hygiene Commission. 

To the Mental Hygiene Commission, also, school sup- 
erintendents should be required to report all feeble- 
minded children at the time they leave school. 

The Mental Hyoriene Commission, with such enlarged 
powers both in the control of the institution and for 
community service, would be expected to organize more 
effectively the scientific work of the hospitals and the 
training school, to provide for more effective use of 
nurses and occupational therapy, and to supply psy- 
chiatric social workers to do the community work already 
outlined both in the clinics and in the community. 

19. Cost of Administration. 

This increased work of the suggested Mental Hygiene 
Commission, requiring more physicians, more nurses and 
social workers, and an enlarged sphere of activity for 
the commissioner, as well as the enlargement of the 

89 



state institution, the purchase of land, and the erection of 
buildings, will mean a great outlay of money. 

Likewise, the organization of special schools for men- 
tal defectives in the public school system will mean in- 
creased expense. 

We may consider that these activities are all going on 
at the present time. The gestures, however, are poorly 
executed. We are not putting over what we attempt. 
We are not training feebleminded children. They are 
compelled to attend school and made to hate it. It will 
cost a little more to educate them properly, but we can 
easily see the savings effected. They will more than 
repay the costs. Delinquent children and adults who 
are mentally defective are being mishandled in various 
courts and reformatory institutions. It will cost no 
more to treat them properly according to scientific stan- 
dards to prevent them from committing their present 
depredations and multiplying their kind to the incalcula- 
ble expense of the taxpayers of the future. 

With all the great progress that has been made in 
Maryland in the past 25 years, indicated by the splen- 
did work of the Lunacy Commission in the five state 
institutions, the state is still spending much less upon 
her mentally diseased and mentally defective than are 
Massachusetts and New York. From the annual report 
of the Comptroller of the Treasury of the State of Mary- 
land for the fiscal year ended September 30, 1920, the 
total expenditures for the care of the insane and the fee- 
bleminded, including the appropriations to the Sylvan 
Retreat and Mt. Hope Retreat and for insane convicts, 
adds up to $938,611.49. The total disbursements from 
the treasury for the same year were $13,304,346.04. 
These expenditures for the mentally diseased and men- 
tally defective in Maryland, therefore, constituted 7.05 
per cent of the total expenditures. 

In Massachusetts, for the ended in 1920, 13.4 per cent 
of all state expenditures were for the insane, feeble- 
minded, and epileptic. 

In New York, for the year ended in 1920, 15 per 
cent of all state expenditures were for the insane, feeble- 
minded, and epileptic, and this excluded the hospitals at 
iJannemora and Matteawan, since these institutions are 
under the prison department. It is seen, therefore, that 
Maryland might double her expenditures in this field of 
mental hygiene and not exceed these states in the pro- 
portion of her resources expended upon the mentally 
diseased and defective. 

90 



Recommendations. 

1. Special Schools for Mental Defectives. 

Special schools should be organized in Baltimore and 
throughout the state for the special training suited to the 
development of mentally defective children. A state ap- 
propriation designed to pay some substantial part of the 
salaries of specially trained teachers engaged in teaching 
such special schools will both facilitate the organization 
of these schools and provide for the special supervision of 
their organization by the state superintendent and by the 
superintendent of Baltimore schools in their respective 
spheres. 

2. School Clinics. 

Clinics for the study of the mental equipment of prob- 
lem children, for diagnosing such cases and prescribing for 
the same, constitute the necessary means of getting the 
right children into these special classes. At the same time 
they will perform very useful service in cases of problem 
children who are not mental defectives. Such a clinic 
under the State Board of Education will necessarily be a 
traveling clinic. It must needs go to the school. These 
clinics will study the children. They are not conceived of 
primarily as efficiency bureaus. Educational tests are not 
their concern. The tests that concern them are tests that 
reveal the nature of the child's mind and character and the 
anomalies therein subject to correction by school activi- 
ties. They are intended to serve all children in any wise 
anomalous. The clinic may often supply useful correction 
in the case of a child whose parents and teachers are un- 
aware of abnormality. Through these clinics, both in Bal- 
timore and in the counties, the school authorities should 
be given by legislative action the vocational guidance now 
in the hands of the State Board of Labor and Statistics, 
and also vocational probation of backward children. 

3. Colonies for Mental Defectives. 

Considerable enlargement of present facilities for the 
training of mentally defective children in the state institu- 
tion is indicated by the results of this survey. The state 
needs a doubling of the facilities at present afforded by 
Rosewood, strictly for training children. 

There is need for the development of colonies for adult 
males and females. This enlargement of the service calls 
for the purchase of more land. We recommend the pur- 
chase of not less than 1,000 acres. This land should be of 
good quality for agricultural service and should be located 

91 



as near the training school as it is possible to obtain farms 
at purely agricultural values. On this new tract there 
should be established, first, a colony for adult males, with 
some buildings suitable for defective delinquent males. 
The colony for adult females we recommend locating on 
the Rosewood tract near the training school. 

We recommend the erection of buildings on the new 
tract of land for a colony for colored feebleminded for 
whom no provision is now made. 

4. Epileptic Hospital. 

Maryland needs a hospital for epileptics — a new insti- 
tution in which it will be possible to receive epileptic chil- 
dren as well as adults, male and female, sane and insane. 

5. State Hospital Psychopathic Service. 

We recommend the completion at the earliest possible 
date of the Foster Clinic at Spring Grove State Hospital, 
putting it into the state service, and changing the law for 
the commitment of the insane so as to admit of voluntary 
admission and of emergency commitment by physicians 
and by police. We also recommend connecting this psycho- 
pathic hospital service with the people of Baltimore by 
ambulance service. 

6. Establishing of a Mental Hygiene Commission. 

We recommend the reconstruction of the Lunacy Com- 
mission and an enlargement of its field of activities under 
the name of the Maryland Mental Hygiene Commission, 
this Commission to consist of four members. Three are 
to be appointed by the governor, one for two years, one 
for four years and one for six years, and thereafter each 
successor is to be appointed for six-year terms. These 
members shall be physicians. 

These three members shall elect an executive officer to 
be designated Commissioner of Mental Hygiene. This 
commissioner will be ex-officio a member of the Commis- 
sion and shall serve as the chairman of the Commission. 
He shall receive such salary as will secure the whole time 
service of a thoroughly competent psychiatrist and ex- 
ecutive. The other members of the Commission we recom- 
mend shall have a per diem stipend for such days as they 
give to the service. 

The Maryland Mental Hygiene Commission is to be 
given the power of appointing superintendents of state 

92 



hospitals and training schools with the approval, in each 
case, of the local board of managers. The Maryland 
Mental Hygiene Commission should also have the power 
of removal of superintendents for proved incompetence 
or mismanagement. 

The Commission of Mental Hygiene through its exec- 
utive officer, the commissioner, should be made responsi- 
ble for the care of the patients in these state institutions, 
the medical and nursing work, the psychopathic, patho- 
logic and sociologic studies, the parole and discharge of 
patients, the visiting clinics, and the field work with 
paroled patients and also for the community oversight 
of feebleminded persons committed to the care of the 
Commission, but kept in their own homes or boarded out 
in the community in the same way as patients paroled 
from institutions. They should be given the power and 
duty of inspecting and licensing private hospitals, sani- 
taria, and boarding homes for the insane and the feeble- 
minded. 

7. Commitment Lau\ for Mental Defectives. 

We recommend the passage of a law which will pro- 
vide for the commitment, training, and custody of fee- 
bleminded persons. This law should 

1. Define the term mental defective. 

2. Detail in simple language the procedure it is nec- 
essary to follow in order to have a mentally defective 
person committed to a state institution or to the care of 
the Mental Hygiene Commission. 

3. Name the court or courts that are to have juris- 
diction in such cases. 

4. Provide a method of making application to the 
court for commitment. 

5. Provide for the court's securing competent mental 
examination and all necessary advice as to treatment 
and disposition of the case. 

6. Provide for the court's holding a hearing either 
public, in chambers, or anywhere the court deems most 
suitable, and give the court power to exclude all but cer- 
tain friends of the person under examination and such 
experts and legal witnesses as are necessary to protect 
the interests of the person examined. 

7. Provide that the certificates of the examiners shall 
give all data concerning the physical and mental condition 
of the person examined and of his family history that is 

93 



required by the Mental Hygiene Commission in such cases, 
and provide for this record's being sent with the order for 
commitment to the institution or to the care of the Men- 
tal Hygiene Commission. 

8. Provide that an order of commitment shall be issued 
by the court when, after such procedure, the court judges 
this to be the best disposition for the individual and 
for the community. 

9. Provide for emergency commitment whereby the 
superintendent of an institution may be empowered to re- 
ceive for 20 days' care any person for whom such care is 
certified to be necessary by a police officer or by a physi- 
cian, provided that on or before the expiration of the 20 
days, such person shall either be duly committed or dis- 
charged. 

10. Provide for voluntary admission to a state insti- 
tution on application by parent or guardian or other prop- 
erly responsible person to the superintendent for such re- 
ception ; any patient so admitted to be allowed to withdraw 
only after 20 days' notice has been served of his inten- 
tion to withdraw. If, in the meantime, the person has 
been found to be a defective whose unsupervised freedom 
in the community might work to the detriment either of 
himself or of others, the superintendent shall take meas- 
ures to have him duly committed. 

11. Provide that the superintendent and the Commis- 
sion be given power to parole and to discharge any and 
every person committed to their care when it appears to 
them to be in the best interests of the individual and of 
the community that such parole or discharge should be 
made; it being understood, however, that no person shall 
be paroled from the care of the Commission or institution 
except when, after investigation' of the home and neigh- 
borhood, there is assurance of the safety of the person 
and of the community, and when provision is made for 
frequent visits and reports ; and that no discharge of such 
patient shall be made by such Commission or superin- 
tendent except when it is found that the person to be dis- 
charged is not a mental defective in the sense of the act. 

12. Provide that county superintendents of schools and 
the superintendent of the schools of Baltimore shall report 
to the Mental Hygiene Commission the names of all men- 
tally defective children dropping out of school at the time 
that they cease to attend school. Make it the duty of 
school officials and health authorities and the police to 
apply for and secure the commitment of feebleminded per- 

94 



sons to the care of the Mental Hygiene Commission or to 
a state institution. 

13. Provide for the transfer of feebleminded persons 
from the Penitentiary and House of Correction to a state 
institution for the feebleminded when such persons are 
found by the Mental Hygiene Commission to be defective 
delinquents and at the same time persons suitable for con- 
trol in the state institution. Provide for the detention of 
these after the expiration of sentence^ and for the transfer 
back to the Board of Prison Control of any inmate who 
proves unmanageable in the buildings provided for de- 
fectives delinquents. 

14. Provide that in the case of any person under arrest 
or charged with the commission of a misdemeanor, felony, 
or other offense, or under indictment for the same, or un- 
dergoing trial for alleged offense, when there appears rea- 
sonable ground for inference that such person is a mental 
defective, the court shall order proceedings, as in the case 
of a person for whom application has been made, that he 
be committed as a mental defective to the Mental Hygiene 
Commission or to an institution for the care of mental 
aeiectives. 

15. Provide for the transfer of patients, by the Mental 
Hygiene Commission, from any one institution under their 
management to any other such institution. 

16. Provide that no mentally defective person may 
legally marry. Make it a felony to have sexual inter- 
course with any female person who has been committed as 
a mental defective to the care of the Mental Hygiene Com- 
mission, or to any institution for the care of mental de- 
fectives, when such person continues under such commit- 
ment and has not been definitely and fully discharged 
therefrom by court, by the superintendent of the institu- 
tion or by the Mental Hygiene Commission. Make it a 
felony to aid or facilitate in any way intercourse with 
such mentally defective female persons. 

8. Courts. 

We recommend that measures be taken to make the 
court dealing with children's cases in Baltimore a branch 
of the Supreme Court of Baltimore City, and that it be 
organized as a court of domestic relations with fully or- 
ganized clinical facilities and probation service. We rec- 
ommend statutory provision for the use of the interme- 
diate sentence in all courts. 

95 






9. Clinical Service for the Board of Prison Control. 

We recommend provision for the thorough mental, as 
well as physical examination of all incoming prisoners, 
and the organization of occupations within the institu- 
tions and of the whole personnel of the institutions about 
the central idea of improving the state of mind of the 
offender. When the persons in charge of this board have 
culled from among the cases in its care all the insane and 
the clearly, mentally defective, the board will be relieved 
of the unimprovable cases. Every energy of the institu- 
tion should be directed toward remaking the character of 
every person who comes from the courts to either of these 
institutions. The character must be understood before it 
can be made over, and the mental clinic is necessary for 
this understanding. 



i)6 



LIBRARY OF CONGRESS ^ 

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20TH CENTURY PRINT 
BALTIMORE, MD. 



